Risk Factors Associated With Myocardial Infarction in Africa

Steyn, Krisela; Sliwa, Karen; Hawken, Steven; Commerford, Patrick; Onen, Churchill Lukwiya; Damasceno, Albertino; Ôunpuu, Stephanie; Yusuf, Salim

doi:10.1161/circulationaha.105.563452

Cited by 291 publications

(301 citation statements)

References 17 publications

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“…In order to tackle the global burden of CVD, some regions of the world have adopted critical measures, including primary prevention strategies that include early detection and targeted control of conventional modifiable risk factors [10,21,22]. In the Middle East, nine modifiable CV risk factors, including the six risk factors analyzed in the present study, almost completely explain the risk of acute myocardial infarction in this region [21].…”

Section: Discussionmentioning

confidence: 73%

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

Radaideh¹,

Tzemos²,

Ali³

et al. 2017

ICFJ

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Highlights BackgroundThe Africa Middle East (AfME) Cardiovascular Epidemiological (ACE) study demonstrated that cardiovascular risk factors are highly prevalent among relatively young adult outpatients attending general practice clinics across AfME regions. ObjectiveBased on broader AfME estimates from the ACE Study, this sub-analysis evaluated the prevalence of cardiovascular risk factors in the United Arab Emirates (UAE), particularly in rural and urban cohorts attending general practice clinics. MethodsData from the cross-sectional ACE study were used, comprising stable, adult outpatients attending general practice clinics in the UAE. The prevalence of six cardiovascular risk factors was analyzed: hypertension, diabetes, dyslipidemia, obesity, smoking, abdominal obesity. Rural populations were defined as living >50km from urban centers, or lack of transportation. ResultsIn this cohort of 495 patients (aged 45.1 years; 49.8% female) from the UAE, a high prevalence of abdominal obesity (71.5%) and dyslipidemia (74.0%) was found. Nearly half of patients had hypertension (43.0%) and one-third diabetes (32.4%). Nearly all outpatients (92.9%) had ≥1 modifiable risk factor (74.9% had ≥1, 59.7% had ≥3). Observations were similar by gender, and across urban and rural centers. Many outpatients with pre-existing hypertension or dyslipidemia did not meet recognized blood pressure or low-density lipoprotein cholesterol goals. ConclusionsCardiovascular risk factors are prevalent among relatively young adult, clinically stable outpatients attending clinics across the UAE. These findings support targeted screening of outpatients visiting a general practitioner, which may provide opportunity for early discovery and ongoing management of risk factors, including recommending lifestyle changes. The ACE trial is registered under NCT01243138.

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Section: Discussionmentioning

confidence: 73%

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

Radaideh¹,

Tzemos²,

Ali³

et al. 2017

ICFJ

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“…Increasing age, male sex, diabetes mellitus, dyslipidemia, hypertension, lower income status, increased serum creatinine, and smoking are all cardiovascular risk factors associated with a higher risk of developing obstructive CAD 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37. Presence of chronic obstructive pulmonary disease, peripheral vascular disease, and a Charlson comorbidity index score are all measures of comorbidity that may affect a clinician's decision‐making process with respect to choosing a suitable initial diagnostic test 38.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Roifman

Wijeysundera

Austin

et al. 2017

JAHA

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BackgroundThe optimal initial noninvasive diagnostic testing strategy for stable coronary artery disease (CAD) is unknown. Although American guidelines recommend an exercise stress test as the first‐line test, European guidelines suggest that stress imaging (myocardial perfusion imaging or stress echocardiography) or coronary computed tomography angiography may be preferable. Understanding the relationship between the initial strategy and downstream yield of obstructive CAD and major adverse cardiac events may provide insight as to the optimal strategy.Methods and ResultsWe conducted a population‐based retrospective cohort study of adults in Ontario, Canada, using health administrative and clinical data. The relationship between the initial testing strategy and obstructive CAD on invasive angiography was examined. Patients were then followed from their angiogram onward to determine whether they developed a composite end point of major adverse cardiac events. After adjusting for covariates, patients with initial myocardial perfusion imaging (odds ratio: 0.92; 95% confidence interval, 0.85, 1.00), coronary computed tomography angiography (odds ratio: 1.51; 95% confidence interval, 0.91, 2.49), or stress echo (odds ratio: 0.95; 95% confidence interval, 0.84, 1.08) did not a have significantly different yield of obstructive CAD compared with those with an initial exercise stress test. Furthermore, there was no significant difference in downstream major adverse cardiac events after invasive angiography among the 4 initial testing strategies after adjusting for clinically relevant covariates.ConclusionsOur study found no evidence to suggest significant differences in either yield of obstructive CAD or downstream major adverse cardiac events in patients undergoing an initial noninvasive testing strategy with stress or anatomical imaging compared with those undergoing an initial exercise stress test.

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“…This means that more people are exposed to these risk factors for long enough periods to cause CAD. [81][82][83] …”

Section: Communicable Diseasesmentioning

confidence: 99%

Cardiovascular risk factors in sub-Saharan Africa: a review

Monti¹,

Ruggieri²,

Vincentelli

et al. 2015

Ital J Med

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Ischemic heart disease is increasing dramatically in the Sub-Saharan Africa (SSA), despite an increasing prevalence of risk factors, and some characteristics of the African people that make the African population subject to the effects of major cardiovascular risk factors. The pace and direction of economic development, rates of urbanization, the changes in life expectancy, associated with different pathophysiological factors are causing an increased rate of atherosclerotic disease in these countries. The prevalence of ischemic heart disease in SSA has shown a significant rise in the next two following decades due to the rising prevalence of risk factors, especially hypertension, diabetes, overweight and obesity, physical inactivity, tobacco use and the dyslipidemia, mainly due to an increase in urbanization. Moreover, thanks to new knowledge, it has been pointed out the difference of individual risk factors in the African population and other populations due to genetic differences. It is estimated that age-standardized approach for ischemic heart disease mortality rates will rise by 27% in African men and 25% in women by 2015 and by 70 and 74%, respectively by 2030. More research is needed in Africa to provide evidence for cardiovascular prevention and treatment to mitigate the oncoming epidemic. Health interventions are needed for preventing or reducing the morbidity/mortality and should be addressed to both children and adults, including score of the risk stratification modified, starting early and aggressive therapy, if necessary.

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Risk Factors Associated With Myocardial Infarction in Africa

Cited by 291 publications

References 17 publications

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

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

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Cardiovascular risk factors in sub-Saharan Africa: a review

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