Poor cardiovascular health associated with subclinical atherosclerosis in apparently healthy sub-Saharan African populations

1. The American Heart Association’s cardiovascular health index has clinical utility with an understudied sub-Saharan African population.

2. The targets for preventing atherosclerosis in this population are smoking, obesity, hypertension, hyperglycemia, and physical activity.

Evidence Rating Level: 3 (Average)

The American Heart Association’s cardiovascular health index (CVHI) is known to be a simple, valid, and translatable metric for cardiovascular health monitoring. This metric includes seven risk factors: dietary intake, smoking, body mass index, physical activity, blood pressure, total cholesterol, and glucose. This cross-sectional study sought to expand evidence of the CVHI’s utility with an underrepresented sub-Saharan African population. Participants were residents of Burkina Faso, Ghana, Kenya, and South Africa. A total of 9,011 participants (M [SD] age = 51 [7] years, 51% female) were included and had a mean CVHI score of 10.3 (SD = 2.0) and common carotid intima-media thickness (CIMT) of 637 (SD = 117μm). CVHI and common CIMT were found to be inversely associated across the countries of Burkina Faso (B-coefficients = 6.51, 95% CI -9.83 to -3.20 μm), Ghana (-5.42, 95% CI -8.90 to -1.95 μm), Kenya (-6.58, 95% CI -9.05 to -4.10 μm), and South Africa (-7.85, 95% CI -9.65 to -6.05 μm). Men (-6.27, 95% CI -7.91 to -4.64) and women (-4.44, 95% CI -6.23 to -2.65) were inversely related. Interestingly, hyperglycemia (p<.001), physical activity (p<.001), and smoking (p<.001) were each related to CIMT in women while only obesity and blood pressure were related to CIMT in both women and men (p<.001). Overall, this study demonstrated the utility of the CVHI among this understudied population, with risk factors differing between men and women. In general, the prevention of atherosclerotic cardiovascular disease requires careful attention to smoking, obesity, hypertension, hyperglycemia, and physical activity.

Click to read the study in BMC Medicine

Image: PD

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