Cardiovascular risk factor burden in Africa and the Middle East: the Africa Middle East Cardiovascular Epidemiological (ACE) study.

Rachel A Nugent,Alawi A Alsheikh-Ali,Omar Hamoui,Frederick J Raal,Walid M Mashhoud,Wafa Rashed,Mohamed I Omar,Paula Abreu,Mohamed Alami,Abdoul Kane

doi:10.1371/journal.pone.0102830

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.

Highlights

Conventional risk factors for cardiovascular (CV) disease are becoming increasingly prevalent worldwide and underlie the growing global burden of non-communicable diseases [1,2]
Cardiovascular risk factors are highly prevalent among relatively young, stable outpatients attending general practice clinics across AfME
While developing countries are expected to account for 80% of global deaths from CV disease, little systematic epidemiological data on CV risk factors are available from these countries [3,4]

Summary

Introduction

Conventional risk factors for cardiovascular (CV) disease are becoming increasingly prevalent worldwide and underlie the growing global burden of non-communicable diseases [1,2]. While developing countries are expected to account for 80% of global deaths from CV disease, little systematic epidemiological data on CV risk factors are available from these countries [3,4]. The proportion of individuals living in urban centers in the developing world has doubled between 1970 and 1994, and is expected to double again by 2025 [8]. This rapid urbanization has occurred in parallel with a rising burden of chronic diseases, but developments in national preventive health systems and screening programs have trailed behind. Developing countries account for ,80% of global cardiovascular (CV) deaths, but contribute a paucity of systematic epidemiological data on CV risk factors

Methods

Results

Discussion

Conclusion