Cardiovascular Risk Factor Burden in Africa and the Middle East: The Africa Middle East Cardiovascular Epidemiological (ACE) Study

Abstract

BackgroundIncreased urbanization in the developing world parallels a rising burden of chronic diseases. Developing countries account for ∼80% of global cardiovascular (CV) deaths, but contribute a paucity of systematic epidemiological data on CV risk factors.ObjectiveTo estimate the prevalence of CV risk factors in rural and urban cohorts attending general practice clinics in the Africa and Middle East (AfME) region.MethodsIn a cross-sectional epidemiological study, the presence of CV risk factors (hypertension, diabetes mellitus (diabetes), dyslipidemia, obesity, smoking and abdominal obesity) were evaluated in stable adult outpatients attending general practice primary care clinics. A rural population was defined as isolated (>50 km or lack of easy access to commuter transportation) from urban centers.Results4,378 outpatients were systematically recruited from 94 clinics across 14 AfME countries. Mean age was 46±14 years and 52% of outpatients were female. A high prevalence of dyslipidemia (70%) and abdominal obesity (68%) were observed, followed by hypertension (43%) and diabetes (25%). The vast majority of outpatients (92%) had at least one modifiable CV risk factor, many (74%) had more than one, and half (53%) had 3 or more. These findings were observed in both genders and across urban and rural centers. Among outpatients with pre-existing hypertension or dyslipidemia, many were not at their target blood pressure or LDL-cholesterol goals.ConclusionCardiovascular risk factors are highly prevalent among relatively young, stable outpatients attending general practice clinics across AfME. The findings support opportunistic screening for CV risk factors whenever outpatients visit a general practitioner and provide an opportunity for early identification and management of CV risk factors, including lifestyle interventions.

Cardiovascular Risk Factor Burden in the United Arab Emirates (UAE): The Africa Middle East (AfME) Cardiovascular Epidemiological (ACE) Study Sub-analysis

“…The ACE study has been described in full elsewhere [14]. Briefly, it was a cross-sectional epidemiological study conducted in clinics across the AfME region between July 2011 and April 2012 [14].…”

“…Briefly, it was a cross-sectional epidemiological study conducted in clinics across the AfME region between July 2011 and April 2012 [14]. This sub-analysis evaluated only data generated from the UAE region.…”

“…This sub-analysis evaluated only data generated from the UAE region. Site selection in the UAE, was based on the ability of a site to conduct clinical studies and the availability of clinical research expertise, infrastructure and ethical oversight, as designated in the ACE protocol [14].…”

“…The study protocol therefore conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's human research committee. The ACE study was registered on clinicaltrials.gov under the identifier: NCT01243138 [14].…”

“…Therefore, the contribution of CV risk from the UAE into the AfME region is quite significant, and therefore warrants specific analysis. The Africa Middle East Cardiovascular Epidemiological (ACE) study was undertaken to estimate the prevalence of CV risk factors in outpatients attending general practice and nonspecialist clinics in urban and rural communities across the AfME region [14]. We sought to conduct a sub-analysis of UAE data collected in the ACE cross-sectional study, in order to determine the prevalence of CV risk factors in outpatients attending urban and rural general practice clinics specifically in the UAE.…”