Ideal cardiovascular health among Ghanaian populations in three European countries and rural and urban Ghana: the RODAM study

Abstract

Cardiovascular health (CVH) is a construct defined by the American Heart Association (AHA) as part of its 2020 Impact Goal definition. CVH has, until now, not been evaluated in Sub-Saharan African populations. The aim of this study was to investigate differences in the prevalence of ideal CVH and its constituent metrics among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in three European countries. The AHA definition of CVH is based on 7 metrics: smoking, body mass index, diet, physical activity, blood pressure, total cholesterol, and fasting plasma glucose. These were evaluated among 3510 Ghanaian adults (aged 25–70 years) residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin) in the multi-centre RODAM study. Differences between groups were assessed using logistic regression with adjustments for gender, age, and education. Only 0.3% of all participants met all 7 metrics of the AHA’s definition of ideal CVH. Compared to rural Ghana (25.7%), the proportions and adjusted odds ratio (OR) of individuals who had 6–7 CVH metrics in the ideal category were substantially lower in urban Ghana, (7.5%; OR 0.204, 95% CI 0.15–0.29), Amsterdam (4.4%; 0.13, 0.08–0.19), Berlin (2.7%; 0.06, 0.03–0.11), and London (1.7%; 0.04, 0.02–0.09), respectively. The proportion of ideal CVH for the various metrics ranged from 96% for all sites in the smoking metric to below 6% in the diet metric. The proportion of ideal CVH is extremely low in Ghanaians, especially among those living in urban Ghana and Ghanaian migrants in Europe.Electronic supplementary materialThe online version of this article (10.1007/s11739-018-1846-6) contains supplementary material, which is available to authorized users.

Ideal Cardiovascular Health Index and Its Determinants in a Rural South African Population

“…Men were far more likely to be a current smoker, and women were almost three-fold more likely to be overweight. These results are in line with patterns observed by van Nieuwenhuizen, et al [ 7 ], in a study undertaken in Ghana, and supported by the meta-analysis by Peng, et al [ 5 ]. On the contrary, no sex-dependent association with BMI was observed in these studies [ 5 ].…”

“…However, only one study from Africa was included (Uganda), reporting good CVH for 58.6% (51.1–65.0, 95% CI) of the population [ 5 ]. A recent study conducted in rural Ghana, found a good CVH for 60.8% of the population [ 7 ]. The estimate of good CVH of 53% as found in the current analysis is lower than these estimates, but considerably higher than the global estimate found in the meta-analysis.…”

“…The Ideal Cardiovascular Health Index (CVHI) is used by the American Heart Association (AHA) as a tool to summarize cardiovascular health (CVH), and amalgamate traditional risk factors for CVD including smoking, overweight, high glucose, high total cholesterol, high blood pressure, unhealthy diet, and physical inactivity [ 4 ]. Several studies have already reported the CVHI, however only two studies have investigated CVHI in SSA [ 5 6 7 ].…”

Poor cardiovascular health is associated with subclinical atherosclerosis in apparently healthy sub-Saharan African populations: an H3Africa AWI-Gen study

“…Similarly, data from the Behavioral Risk Factor Surveillance System study which used information obtained telephonically from nearly 1.4 million subjects in the USA reported a much lower prevalence of iCVH (5.1%) in 2009 than reported in the current study [28]. The iCVH levels among our participants from Ghana was 50.9% and higher than reported by the Research on Obesity and Diabetes among African Migrants (RODAM) study conducted among Ghanaians residing in rural (25.7%) and urban (7.5%) areas and their counterparts in the diaspora (< 5%) [29]. Further to this, a systematic review by Peng et al showed that participants from Africa were likely to have higher proportions of ideal CVH compared to North and South Americans, Asians, Europeans, and the Oceania's [30].…”

Family medicine residency training in Ghana after 20 years: resident attitudes about their education

“… 16 Unfortunately, previous data suggest Ghanaians have much worse cardiovascular health compared with the European population. 17 18 Additionally, research has shown that having a health system that allows access, awareness and education to diabetes and hypertension resources will improve the outcome of these illnesses. 19 While a system based on family medicine seems an obvious solution, family medicine faces a significant challenges.…”