Poor cardiovascular health is associated with subclinical atherosclerosis in apparently healthy sub-Saharan African populations: an H3Africa AWI-Gen study
Engelbert A. Nonterah,
Nigel J. Crowther,
Abraham Oduro,
Godfred Agongo,
Lisa K. Micklesfield,
Palwendé R. Boua,
Solomon S. R. Choma,
Shukri F. Mohamed,
Herman Sorgho,
Stephen M. Tollman,
Shane A. Norris,
Frederick J. Raal,
Diederick E. Grobbee,
Michelé Ramsay,
Michiel L. Bots,
Kerstin Klipstein-Grobusch,
as part of the H3Africa AWI-Gen study
Affiliations
Engelbert A. Nonterah
Clinical Sciences Department, Navrongo Health Research Centre, Ghana Health Service
Nigel J. Crowther
Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Services, University of the Witwatersrand
Abraham Oduro
Clinical Sciences Department, Navrongo Health Research Centre, Ghana Health Service
Godfred Agongo
Clinical Sciences Department, Navrongo Health Research Centre, Ghana Health Service
Lisa K. Micklesfield
MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand
Palwendé R. Boua
Institut de Recherché en Sciences de la Santé, Clinical Research Unit of Nanoro
Solomon S. R. Choma
DIMAMO Health Demographic Surveillance Site, Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo
Shukri F. Mohamed
African Population Health Research Centre
Herman Sorgho
Institut de Recherché en Sciences de la Santé, Clinical Research Unit of Nanoro
Stephen M. Tollman
MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand
Shane A. Norris
MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand
Frederick J. Raal
Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of the Witwatersrand
Diederick E. Grobbee
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University
Michelé Ramsay
Sydney Brenner Institute of Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand
Michiel L. Bots
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University
Kerstin Klipstein-Grobusch
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University
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.
