Engelbert A Nonterah1,2, Nigel J Crowther3, Abraham Oduro4, Godfred Agongo4, Lisa K Micklesfield5, Palwendé R Boua6, Solomon S R Choma7, Shukri F Mohamed8, Herman Sorgho6, Stephen M Tollman9, Shane A Norris5, Frederick J Raal10, Diederick E Grobbee11, Michelé Ramsay12, Michiel L Bots11, Kerstin Klipstein-Grobusch11,13. 1. Clinical Sciences Department, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana. engelbert.nonterah@navrongo-hrc.org. 2. Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. engelbert.nonterah@navrongo-hrc.org. 3. Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Services, University of the Witwatersrand, Johannesburg, South Africa. 4. Clinical Sciences Department, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana. 5. MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 6. Institut de Recherché en Sciences de la Santé, Clinical Research Unit of Nanoro, Nanoro, Burkina Faso. 7. DIMAMO Health Demographic Surveillance Site, Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa. 8. African Population Health Research Centre, Nairobi, Kenya. 9. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 10. Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 11. Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 12. Sydney Brenner Institute of Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 13. Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
BACKGROUND: The cardiovascular health index (CVHI) introduced by the American Heart Association is a valid, accessible, simple, and translatable metric for monitoring cardiovascular health in a population. Components of the CVHI include the following seven cardiovascular risk factors (often captured as life's simple 7): smoking, dietary intake, physical activity, body mass index, blood pressure, glucose, and total cholesterol. We sought to expand the evidence for its utility to under-studied populations in sub-Saharan Africa, by determining its association with common carotid intima-media thickness (CIMT). METHODS: We conducted a cross-sectional study involving 9011 participants drawn from Burkina Faso, Ghana, Kenya, and South Africa. We assessed established classical cardiovascular risk factors and measured carotid intima-media thickness of the left and right common carotid arteries using B-mode ultrasonography. Adjusted multilevel mixed-effect linear regression was used to determine the association of CVHI with common CIMT. In the combined population, an individual participant data meta-analyses random-effects was used to conduct pooled comparative sub-group analyses for differences between countries, sex, and socio-economic status. RESULTS: The mean age of the study population was 51 ± 7 years and 51% were women, with a mean common CIMT of 637 ± 117 μm and CVHI score of 10.3 ± 2.0. Inverse associations were found between CVHI and common CIMT (β-coefficients [95% confidence interval]: Burkina Faso, - 6.51 [- 9.83, - 3.20] μm; Ghana, - 5.42 [- 8.90, - 1.95]; Kenya, - 6.58 [- 9.05, - 4.10]; and South Africa, - 7.85 [- 9.65, - 6.05]). Inverse relations were observed for women (- 4.44 [- 6.23, - 2.65]) and men (- 6.27 [- 7.91, - 4.64]) in the pooled sample. Smoking (p < 0.001), physical activity (p < 0.001), and hyperglycemia (p < 0.001) were related to CIMT in women only, while blood pressure and obesity were related to CIMT in both women and men (p < 0.001). CONCLUSION: This large pan-African population study demonstrates that CVHI is a strong marker of subclinical atherosclerosis, measured by common CIMT and importantly demonstrates that primary prevention of atherosclerotic cardiovascular disease in this understudied population should target physical activity, smoking, obesity, hypertension, and hyperglycemia.
BACKGROUND: The cardiovascular health index (CVHI) introduced by the American Heart Association is a valid, accessible, simple, and translatable metric for monitoring cardiovascular health in a population. Components of the CVHI include the following seven cardiovascular risk factors (often captured as life's simple 7): smoking, dietary intake, physical activity, body mass index, blood pressure, glucose, and total cholesterol. We sought to expand the evidence for its utility to under-studied populations in sub-Saharan Africa, by determining its association with common carotid intima-media thickness (CIMT). METHODS: We conducted a cross-sectional study involving 9011 participants drawn from Burkina Faso, Ghana, Kenya, and South Africa. We assessed established classical cardiovascular risk factors and measured carotid intima-media thickness of the left and right common carotid arteries using B-mode ultrasonography. Adjusted multilevel mixed-effect linear regression was used to determine the association of CVHI with common CIMT. In the combined population, an individual participant data meta-analyses random-effects was used to conduct pooled comparative sub-group analyses for differences between countries, sex, and socio-economic status. RESULTS: The mean age of the study population was 51 ± 7 years and 51% were women, with a mean common CIMT of 637 ± 117 μm and CVHI score of 10.3 ± 2.0. Inverse associations were found between CVHI and common CIMT (β-coefficients [95% confidence interval]: Burkina Faso, - 6.51 [- 9.83, - 3.20] μm; Ghana, - 5.42 [- 8.90, - 1.95]; Kenya, - 6.58 [- 9.05, - 4.10]; and South Africa, - 7.85 [- 9.65, - 6.05]). Inverse relations were observed for women (- 4.44 [- 6.23, - 2.65]) and men (- 6.27 [- 7.91, - 4.64]) in the pooled sample. Smoking (p < 0.001), physical activity (p < 0.001), and hyperglycemia (p < 0.001) were related to CIMT in women only, while blood pressure and obesity were related to CIMT in both women and men (p < 0.001). CONCLUSION: This large pan-African population study demonstrates that CVHI is a strong marker of subclinical atherosclerosis, measured by common CIMT and importantly demonstrates that primary prevention of atherosclerotic cardiovascular disease in this understudied population should target physical activity, smoking, obesity, hypertension, and hyperglycemia.
Authors: Matthew J Feinstein; June-Ho Kim; Prossy Bibangambah; Ruth Sentongo; Jeffrey N Martin; Alexander C Tsai; David R Bangsberg; Linda Hemphill; Virginia A Triant; Yap Boum; Peter W Hunt; Samson Okello; Mark J Siedner Journal: AIDS Res Hum Retroviruses Date: 2016-09-07 Impact factor: 2.205
Authors: Vanessa Xanthakis; Danielle M Enserro; Joanne M Murabito; Joseph F Polak; Kai C Wollert; James L Januzzi; Thomas J Wang; Geoffrey Tofler; Ramachandran S Vasan Journal: Circulation Date: 2014-10-01 Impact factor: 29.690
Authors: David C Goff; Donald M Lloyd-Jones; Glen Bennett; Sean Coady; Ralph B D'Agostino; Raymond Gibbons; Philip Greenland; Daniel T Lackland; Daniel Levy; Christopher J O'Donnell; Jennifer G Robinson; J Sanford Schwartz; Susan T Shero; Sidney C Smith; Paul Sorlie; Neil J Stone; Peter W F Wilson Journal: J Am Coll Cardiol Date: 2013-11-12 Impact factor: 24.094
Authors: K Ekoru; G A V Murphy; E H Young; H Delisle; C S Jerome; F Assah; B Longo-Mbenza; J P D Nzambi; J B K On'Kin; F Buntix; M C Muyer; D L Christensen; C S Wesseh; A Sabir; C Okafor; I D Gezawa; F Puepet; O Enang; T Raimi; E Ohwovoriole; O O Oladapo; P Bovet; W Mollentze; N Unwin; W K Gray; R Walker; K Agoudavi; S Siziya; J Chifamba; M Njelekela; C M Fourie; S Kruger; A E Schutte; C Walsh; D Gareta; A Kamali; J Seeley; S A Norris; N J Crowther; D Pillay; P Kaleebu; A A Motala; M S Sandhu Journal: Int J Obes (Lond) Date: 2017-10-03 Impact factor: 5.095