The Lancet Regional Health. Americas (May 2024)

Spectrum of prevalent cardiovascular diseases in urban Port-au-Prince, Haiti: a population-based cross-sectional studyResearch in context

  • Lily D. Yan,
  • Rodney Sufra,
  • Reichling St Sauveur,
  • Marie Christine Jean-Pierre,
  • Alexandra Apollon,
  • Rodolphe Malebranche,
  • Michel Théard,
  • Gerard Pierre,
  • Jessy Dévieux,
  • Jennifer Lau,
  • Nour Mourra,
  • Nicholas L.S. Roberts,
  • Rehana Rasul,
  • Denis Nash,
  • Altaf M. Pirmohamed,
  • Richard B. Devereux,
  • Myung Hee Lee,
  • Gene F. Kwan,
  • Monika M. Safford,
  • Lauré Adrien,
  • Jean Patrick Alfred,
  • Marie Deschamps,
  • Patrice Severe,
  • Daniel W. Fitzgerald,
  • Jean W. Pape,
  • Vanessa Rouzier,
  • Margaret L. McNairy,
  • Lily D. Yan,
  • Rodney Sufra,
  • Reichling St Sauveur,
  • Marie Christine Jean-Pierre,
  • Jean Lookens Pierre,
  • Alexandra Apollon,
  • Rodolphe Malebranche,
  • Michel Théard,
  • Gerard Pierre,
  • Jessy Dévieux,
  • Jennifer Lau,
  • Nour Mourra,
  • Miranda Metz,
  • Caleigh Smith,
  • Shalom Sabwa,
  • Adrienne Clermont,
  • Nicholas L.S. Roberts,
  • Rehana Rasul,
  • Denis Nash,
  • Altaf M. Pirmohamed,
  • Richard B. Devereux,
  • Myung Hee Lee,
  • Gene F. Kwan,
  • Monika Safford,
  • Lauré Adrien,
  • Jean Patrick Alfred,
  • Marie Deschamps,
  • Patrice Severe,
  • Daniel W. Fitzgerald,
  • Jean W. Pape,
  • Vanessa Rouzier,
  • Margaret L. McNairy

Journal volume & issue
Vol. 33
p. 100729

Abstract

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Summary: Background: Eighty percent of global cardiovascular disease (CVD) is projected to occur in low- and middle -income countries (LMICs), yet local epidemiological data are scarce. We provide the first population-based, adjudicated CVD prevalence estimates in Port-au-Prince, Haiti to describe the spectrum of heart disease and investigate associated risk factors. Methods: Demographic, medical history, clinical, imaging and laboratory data were collected among adults recruited using multistage random sampling from 2019 to 2021. Prevalent CVD (heart failure, stroke, ischemic disease) were adjudicated using epidemiological criteria similar to international cohorts. Multivariable Poisson regressions assessed relationships between risk factors and prevalent CVD. Findings: Among 3003 participants, median age was 40 years, 58.1% were female, 70.2% reported income <1 USD/day, and all identified as Black Haitian. CVD age-adjusted prevalence was 14.7% (95% CI 13.3%, 16.5%), including heart failure (11.9% [95% CI 10.5%, 13.5%]), stroke (2.4% [95% CI 1.9%, 3.3%]), angina (2.1% [95% CI 1.6%, 2.9%]), myocardial infarction (1.0% [95% CI 0.6%, 1.8%]), and transient ischemic attack (0.4% [95% CI 0.2%, 1.0%]). Among participants with heart failure, median age was 57 years and 68.5% of cases were among women. The most common subtype was heart failure with preserved ejection fraction (80.4%). Heart failure was associated with hypertension, obesity, chronic kidney disease, depression, and stress. Interpretation: Early-onset heart failure prevalence is alarmingly high in urban Haiti and challenge modelling assumptions that ischemic heart disease and stroke dominate CVDs in LMICs. These data underscore the importance of local population-based epidemiologic data within LMICs to expedite the selection and implementation of evidence-based cardiovascular health policies targeting each country's spectrum of heart disease. Funding: This study was funded by NIH grants R01HL143788, D43TW011972, and K24HL163393, clinicaltrials.gov NCT03892265.

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