Risk of Cardiovascular Disease in a Traditional African Population with a High Infectious Load: A Population-Based Study

Abstract

BackgroundTo test the inflammatory origin of cardiovascular disease, as opposed to its origin in western lifestyle. Population-based assessment of the prevalences of cardiovascular risk factors and cardiovascular disease in an inflammation-prone African population, including electrocardiography and ankle-arm index measurement. Comparison with known prevalences in American and European societies.Methodology/Principal FindingsTraditional population in rural Ghana, characterised by adverse environmental conditions and a high infectious load. Population-based sample of 924 individuals aged 50 years and older. Median values for cardiovascular risk factors, including waist circumference, BMI, blood pressure, and markers of glucose and lipid metabolism and inflammation. Prevalence of myocardial infarction detected by electrocardiography and prevalence of peripheral arterial disease detected by ankle-arm index. When compared to western societies, we found the Ghanaians to have more proinflammatory profiles and less cardiovascular risk factors, including obesity, dysglycaemia, dyslipidaemia, and hypertension. Prevalences of cardiovascular disease were also lower. Definite myocardial infarction was present in 1.2% (95%CI: 0.6 to 2.4%). Peripheral arterial disease was present in 2.8% (95%CI: 1.9 to 4.1%).Conclusions/SignificanceTaken together, our data indicate that for the pathogenesis of cardiovascular disease inflammatory processes alone do not suffice and additional factors, probably lifestyle-related, are mandatory.

Determinants of epidemiologic transition in rural Africa: the role of socioeconomic status and drinking water source

“…11,12,14 Infectious diseases such as malaria, meningitis, typhoid fever and acute respiratory infections are highly endemic and constitute the main causes of death. [14][15][16][17] During the study, we kept a registry of all of the inhabitants of a specified geographic area in the Garu-Tempane district that comprised of about 375 km 2 and 32 villages. We visited the research area every year from 2002 to 2011.…”

“…16 The progression of agricultural techniques and public health is likely to be accompanied by changes in lifestyle that strongly increase the risk of non-infectious diseases. 2,37 Currently, the primary focus in rural areas is on cure, thereby neglecting prevention and care.…”

“…9,10,25 Other parameters were only measured in selected subgroups. 10,16,17 Finally, we lack certain information on women's fertility, such as changes in age at first birth, time between births, parity and cultural values related to fertility, which would have been valuable in evaluating the epidemiologic transition.…”

Cardiovascular risk factors in sub-Saharan Africa: a review

“…However, the evidence has shown that younger patients (<55 years) were prone to a higher risk of atherosclerotic disease, which decreased ageing. 29 Such difference, could be partially explained by the difficult collection of data about the actual incidence of risk factors among African population, which may lie in the complexity of conducting proper surveys in many countries, in order to perform an accurate risk stratification. In addition, women do not smoke or drink publicly, but it can assume that the women exhibit these [ behaviors privately in smaller proportions.…”

“…This selection of a proinflammatory status is confirmed by the higher levels of the proinflammatory cytokine, including the interleukin-6. 70 The macrophage is a critical component [ in the pathway to atherosclerotic inflammation. During an infectious process causes the activation of macrophages, including the secretion of numerous factors (angiopoietin-related growth factor; transforming growth factor; fibroblast growth factor-1, -2, -4; vascular endothelial growth factor).…”