Cardiovascular Disease In Africa Research Articles

Prescribing patterns of statins and associated factors among type 2 diabetes mellitus patients in Africa: A systematic review and meta-analysis

BackgroundIn sub-Saharan African nations, there's a documented shortfall in the utilization of statins, despite established clinical guidelines advocating their use for reducing cardiovascular risks and overall mortality among Type 2 diabetes patients aged 40–75 years old. Most clinical guidelines recommend prescribing statins to individuals with type 2 diabetes to reduce the chances of cardiovascular disease. There is currently a lack of extensive research on statin utilization specifically for primary prevention of cardiovascular disease in Africa. Thus, this study aimed to assess the prescription patterns of statins for preventing cardiovascular disease in type 2 diabetes patients. MethodsThe findings of the review were presented following the guidelines outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA-2020) checklist. We conducted searches on electronic databases including PubMed, EMBASE, Cochrane Library, Science Direct, African Journal Online, and Google Scholar. This systematic review and meta-analysis included articles that met specific inclusion criteria: observational studies such as cross-sectional, cohort, and case-control studies focusing on determinants, risk factors, or correlates associated with statin prescription within Africa. Only published articles up to June 2, 2024, published in English, and conducted in either community or healthcare facility settings were considered. Data import was initially conducted using Microsoft Excel, and statistical analysis was performed using STATA software. Cochran's Q test was employed to assess whether there was a significant variance in prevalence among the studies. Additionally, the I2 statistic was utilized to quantify the extent of heterogeneity. A funnel plot, a visual tool, was utilized to evaluate publication bias. ResultsThe search strategy resulted in 7695 published original articles. The full texts of the 89 papers were assessed for eligibility and quality. Moreover, some articles were rejected due to inaccuracies in the outcome variable. Ultimately, only ten studies focusing on the prevalence of statin prescription were examined. The research suggests that the pooled prevalence of statin prescription among Type 2 diabetic individuals in Africa is found to be 48.82% (95% CI: 35.41–63.24). Age greater than 65 years (AOR = 3.56, 95% CI: 1.70–7.45; I2 = 54.7%), comorbidity (AOR = 1.13, 95% CI: 0.27–4.63, I2 = 96.4%), dyslipidemia (AOR = 3.15, 95% CI: 1.54–6.44, I2 = 61.7%), DM duration greater than ten years (AOR = 1.36, 95% CI: 0.81–2.28, I2 = 77.3%), and government insurance (AOR = 8.85, 95% CI: 2.72–28.76, I2 = 81.5%) were factors associated with statin prescription among type 2 diabetic patients. ConclusionsIn general, the extent of statin prescriptions for individuals with type 2 diabetes who are eligible for statin therapy was below the target outlined by clinical practice guidelines. Being over 65 years old, having comorbidities, experiencing dyslipidemia, having type 2 diabetes for more than ten years, and having government insurance were all identified as independent factors predicting the prescription of statins. This finding is concerning and underscores the urgent need to enhance adherence to clinical practice guidelines for the well-being of this vulnerable population at high risk.

Understanding and controlling the increasing burden of cardiovascular diseases in Africa.

Understanding and controlling the increasing burden of cardiovascular diseases in Africa.

Meta-Analysis and Multivariate GWAS Analyses in 80,950 Individuals of African Ancestry Identify Novel Variants Associated with Blood Pressure Traits.

High blood pressure (HBP) has been implicated as a major risk factor for cardiovascular diseases in several populations, including individuals of African ancestry. Despite the elevated burden of HBP-induced cardiovascular diseases in Africa and other populations of African descent, limited genetic studies have been carried out to explore the genetic mechanism driving this phenomenon. We performed genome-wide association univariate and multivariate analyses of both systolic (SBP) and diastolic blood pressure (DBP) traits in 80,950 individuals of African ancestry. We used summary statistics data from six independent cohorts, including the African Partnership for Chronic Disease Research (APCDR), the UK Biobank, and the Million Veteran Program (MVP). FUMA was used to annotate, prioritize, visualize, and interpret our findings to gain a better understanding of the molecular mechanism(s) underlying the genetics of BP traits. Finally, we undertook a Bayesian fine-mapping analysis to identify potential causal variants. Our meta-analysis identified 10 independent variants associated with SBP and 9 with DBP traits. Whilst our multivariate GWAS method identified 21 independent signals, 18 of these SNPs have been previously identified. SBP was linked to gene sets involved in biological processes such as synapse assembly and cell-cell adhesion via plasma membrane adhesion. Of the 19 independent SNPs identified in the BP meta-analysis, only 11 variants had posterior probability (PP) of > 50%, including one novel variant: rs562545 (MOBP, PP = 77%). To facilitate further research and fine-mapping of high-risk loci/variants in highly susceptible groups for cardiovascular disease and other related traits, large-scale genomic datasets are needed. Our findings highlight the importance of including ancestrally diverse populations in large GWASs and the need for diversity in genetic research.

In-hospital mortality from acute coronary syndrome in Africa: a systematic review and meta-analysis.

There is an increasing recognition of the burden of cardiovascular disease in Africa. However, little is known about the pooled prevalence of acute coronary syndrome (ACS)-associated in-hospital mortality and contributing factors. PubMed, Medline, Embase, Web of Science (Core Collection), and supplementary sources including Google Scholar, World Cat, Research Gate, and Cochrane Library were searched. Chi-square test and I 2-statistic were used to assess heterogeneity. Egger's and Begg's tests and funnel plots were used to assess publication bias. Data were analyzed using Stata software (version 15.0). Twenty nine studies with a total sample of 11,788 were included. The pooled estimate of all-cause in-hospital mortality was 22% (pooled proportion (PP) = 0.22; 95% confidence interval (CI): 0.17-0.27. The In-hospital mortality rate was lower at the cardiac centers (PP = 0.14; CI: 0.05-0.23) compared to referral hospitals (PP = 0.24; CI: 0.17-0.31]) The mortality rate was comparable in Eastern (PP = 0.23; CI: 0.19-0.27) and Northern Africa (PP = 0.22; CI: 0.16-0.28). The incidence of in-hospital heart failure, cardiogenic shock, arrhythmia, bleeding, acute stroke, and reinfarction were 42, 17.0, 20.0, 16.0, 4.0, and 5.0%, respectively. All-cause in-hospital mortality rate associated with ACS is high in Africa. The mortality rate at cardiac centers was 10% lower when compared with referral hospitals. Establishing coronary units, strengthening existing cardiac services, and improving availability and access to cardiovascular medicines could help in reducing the burden of ACS in the continent.

Cardiovascular diseases in Africa in the twenty-first century: Gaps and priorities going forward.

In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide. There is currently an epidemiological transition on the continent, where NCDs is projected to outpace communicable diseases within the current decade. Unchecked increases in CVD risk factors have contributed to the growing burden of three major CVDs-hypertension, cardiomyopathies, and atherosclerotic diseases- leading to devastating rates of stroke and heart failure. The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa. The contributory causes of heart failure are changing-whilst HHD and cardiomyopathies still dominate, ischemic heart disease is rapidly becoming a significant contributor, whilst rheumatic heart disease (RHD) has shown a gradual decline. In a continent where health systems are traditionally geared toward addressing communicable diseases, several gaps exist to adequately meet the growing demand imposed by CVDs. Among these, high-quality research to inform interventions, underfunded health systems with high out-of-pocket costs, limited accessibility and affordability of essential medicines, CVD preventive services, and skill shortages. Overall, the African continent progress toward a third reduction in premature mortality come 2030 is lagging behind. More can be done in the arena of effective policy implementation for risk factor reduction and CVD prevention, increasing health financing and focusing on strengthening primary health care services for prevention and treatment of CVDs, whilst ensuring availability and affordability of quality medicines. Further, investing in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on interventions. This review summarizes the current CVD burden, important gaps in cardiovascular medicine in Africa, and further highlights priority areas where efforts could be intensified in the next decade with potential to improve the current rate of progress toward achieving a 33% reduction in CVD mortality.

Racial and Ethnic Differences in the Association Between Classical Cardiovascular Risk Factors and Common Carotid Intima-Media Thickness: An Individual Participant Data Meta-Analysis.

BackgroundThe major risk factors for atherosclerotic cardiovascular disease differ by race or ethnicity but have largely been defined using populations of European ancestry. Despite the rising prevalence of cardiovascular disease in Africa there are few related data from African populations. Therefore, we compared the association of established cardiovascular risk factors with carotid‐intima media thickness (CIMT), a subclinical marker of atherosclerosis, between African, African American, Asian, European, and Hispanic populations.Methods and ResultsCross‐sectional analyses of 34 025 men and women drawn from 15 cohorts in Africa, Asia, Europe, and North America were undertaken. Classical cardiovascular risk factors were assessed and CIMT measured using B‐mode ultrasound. Ethnic differences in the association of established cardiovascular risk factors with CIMT were determined using a 2‐stage individual participant data meta‐analysis with beta coefficients expressed as a percentage using the White population as the reference group. CIMT adjusted for risk factors was the greatest among African American populations followed by Asian, European, and Hispanic populations with African populations having the lowest mean CIMT. In all racial or ethnic groups, men had higher CIMT levels compared with women. Age, sex, body mass index, and systolic blood pressure had a significant positive association with CIMT in all races and ethnicities at varying magnitudes. When compared with European populations, the association of age, sex, and systolic blood pressure with CIMT was weaker in all races and ethnicities. Smoking (beta coefficient, 0.39; 95% CI, 0.09–0.70), body mass index (beta coefficient, 0.05; 95% CI, 0.01–0.08) and glucose (beta coefficient, 0.13; 95% CI, 0.06–0.19) had the strongest positive association with CIMT in the Asian population when compared with all other racial and ethnic groups. High‐density lipoprotein‐cholesterol had significant protective effects in African American (beta coefficient, −0.31; 95% CI, −0.42 to −0.21) and African (beta coefficient, −0.26; 95% CI, −0.31 to −0.19) populations only.ConclusionsThe strength of association between established cardiovascular risk factors and CIMT differed across the racial or ethnic groups and may be due to lifestyle risk factors and genetics. These differences have implications for race‐ ethnicity‐specific primary prevention strategies and also give insights into the differential contribution of risk factors to the pathogenesis of cardiovascular disease. The greatest burden of subclinical atherosclerosis in African American individuals warrants further investigations.

Climate Change and Cardiovascular Disease in Africa

Climate Change and Cardiovascular Disease in Africa

Race, geographical location and other risk factors for hypertension: South African National Health and Nutrition Examination Survey 2011/12

BackgroundHypertension is the leading cardiovascular disease in Africa. It is increasing in prevalence due partly to the epidemiological transition that African countries, including South Africa, are undergoing. This epidemiological transition is characterised by a nutrition transition andurbanisation; resulting in behavioural, environmental and stress changes that are subject to racial and geographic divides. The South African National Health and Nutrition Examination Survey (SANHANES) examined the association of traditional risk factors; and less traditional risk factors such as race, geographical location, social stressors and psychological distress with hypertension in a national population-based sample of South Africans. MethodsData were analysed on individuals ≥15 years who underwent a physical examination in the SANHANES (n = 7443). Hypertension was defined by blood pressure ≥140/90 mmHg or self-reported hypertension medication usage. Stepwise regression examined the association of demographic, socioeconomic, life stressors, and health risk factors with systolic blood pressure, diastolic blood pressure, and hypertension. Secondly, the risk factor associations and geographical location effects were investigated separately for the African race group. ResultsIncreasing age (AOR = 1.069, p < 0.001); male gender (AOR = 1.413, p = 0.037); diabetes (AOR = 1.66, p = 0.002); family history of high blood pressure (AOR = 1.721, p < 0.001); and normal weight, overweight and obesity (relative to underweight: AOR = 1.782, p = 0.008; AOR = 2.232, p < 0.001; AOR = 3.874, p < 0.001 respectively) were associated with hypertension. Amongst African participants (n = 5315) age (AOR = 1.068, p < 0.001); male gender (AOR = 1.556, p = 0.001); diabetes (AOR = 1.717, p = 0.002); normal weight, overweight and obesity (relative to underweight: AOR = 1.958, p = 0.006; AOR = 2.118, p = 0.002; AOR = 3.931, p < 0.001); family history of high blood pressure (AOR = 1.485, p = 0.005); and household crowding (AOR = 0.745, p = 0.037) were associated with hypertension. There was a significantly lower prevalence of hypertension in rural informal compared to urban formal settings amongst African participants (AOR = 0.611, p = 0.005). Other social stressors and psychological distress were not significantly associated with hypertension. ConclusionThere was no significant association between social stressors or psychological distress and hypertension. However, the study provides evidence of high-risk groups for whom hypertension screening and management should be prioritised, including older ages, males, people with diabetes or with family history of hypertension, and Africans who live in urban formal localities.

Lifestyle factors associated with the transition from healthy to unhealthy adiposity among black South African adults over 10 years

Background and aimsObesity is associated with an increasing prevalence of cardiovascular diseases in Africa, but some obese individuals maintain cardiometabolic health. The aims were to track metabolically healthy overweight or obesity (MHO) over 10 years in African adults and to identify factors associated with a transition to metabolically unhealthy overweight or obesity (MUO). Methods and resultsThe participants were the South African cohort of the international Prospective Urban and Rural Epidemiological study. From the baseline data of 1937 adults, 649 women and 274 men were followed for 10 years. The combined overweight and obesity prevalence of men (19.2%–23.8%, p = .02) and women (58%–64.7%, p < .001), and the prevalence of the metabolic syndrome in all participants (25.4%–40.2%, p < .001) increased significantly. More than a quarter (26.2%) of the women and 10.9% of men were MHO at baseline, 11.4% of women and 5.1% of men maintained MHO over 10 years, while similar proportions (12.3% of women, 4.7% of men) transitioned to MUO. Female sex, age, and total fat intake were positively associated with a transition to MUO over 10 years, while physical activity was negatively associated with the transition. HIV positive participants were more likely to be MHO at follow-up than their HIV negative counterparts. ConclusionsOne in two black adults with BMI ≥25 kg/m2 maintained MHO over 10 years, while a similar proportion transitioned into MUO. Interventions should focus on lower fat intakes and higher physical activity to prevent the transition to MUO.

SARS-CoV 2 Infection (Covid-19) and Cardiovascular Disease in Africa: Health Care and Socio-Economic Implications

The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones.This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.

Interplay of COVID-19 and cardiovascular diseases in Africa: an observational snapshot.

The COVID-19 pandemic, which started around December 2019 has, at present, resulted in over 450,000 deaths globally, and approximately 1% of these deaths have been reported in Africa. Despite the high prevalence of COVID-19 risk factors, namely: hypertension, diabetes, chronic pulmonary disease, cardiovascular diseases (CVDs) such as rheumatic heart disease, compromised immunity and obesity, low case fatality rates have been recorded in many parts of Africa so far. COVID-19 severity has previously been shown to be worse in patients with CVD and hypertension. We observed the severity of COVID-19 and mortality rates in Africa, and compared outcomes with prevalence of established risk factors (hypertension and CVD). We stratified data as per the United Nations’ 5 African subregions. North African countries show a positive association between the risk factors and the mortality rates from COVID-19. However, we observed discordant patterns in the relationship between COVID-19, and either CVD or hypertension, in sub-Saharan African countries. In this paper, we also review the pathogenesis of SARS-CoV-2 infection and how it worsens CVD and postulate that the differences in modulation of the renin–angiotensin–aldosterone system (RAAS) axis which controls angiotensin-converting enzyme (ACE)/ACE2 balance may be an important determinant of COVID-19 outcomes in Africa.Electronic supplementary materialThe online version of this article (10.1007/s00392-020-01720-y) contains supplementary material, which is available to authorized users.

Effects of cardiopulmonary resuscitation training for Mozambican nursing students in a low-resource setting: An intervention study

BackgroundThere is an increasing incidence of cardiovascular diseases in Africa. Nurses' ability to undertake cardiopulmonary resuscitation (CPR) can significantly impact the survival of patients who experience cardiac arrest. ObjectivesWe aimed to identify the effects of CPR training among Registered Nurse-Bachelor of Science in Nursing (RN-BSN) students in Mozambique. DesignA one-group pretest–posttest repeated-measures quasi-experimental design. SettingAuditorium of a general hospital and 2 Anne manikins, but no automatic external defibrillator. ParticipantsThirty-two RN-BSN students. MethodsStudents' attitudes and self-efficacy on CPR were measured by self-reported questionnaires three times (before, immediately after, and 20 weeks post intervention). Data were analyzed by the paired t-test and repeated-measures analysis of variance. ResultsAttitude and self-efficacy scores of students on CPR significantly increased immediately after CPR training, but decreased 20 weeks after the intervention (p < .001). Sociodemographic characteristics did not significantly differ throughout the measurements of attitude or self-efficacy. ConclusionsCPR manikin training positively affected attitude and self-efficacy in CPR among RN-BSN nursing students immediately, but not at 20 weeks, after the training. There is a need for research to repeatedly quantify parameters in a controlled study at different intervals and develop an instructor-training course customized to Mozambique.

Cardiac surgery publications in Africa over the last 20 years: A literature review

There is a significant burden of surgically correctable cardiovascular disease in Africa. The goal of this research was to review the last 20 years of literature on this topic. A systematic search was performed using PubMed, Embase and African Index Medicus for the period 1996–2016. Publications came from 29 countries, all of different income brackets. Research output increased by 15-fold over the 20-year time period, with the majority of publications authored by local teams (71.4%) compared to visiting (4.9%) and mixed teams (23.7%). Although increasing, clinical reporting on cardiac surgery is still limited. Increased publication of results should be encouraged to better benchmark capacity and improve research capacity.&#x0D; Significance:&#x0D; &#x0D; The majority of the cardiovascular publications came from local research teams affiliated with public hospitals which suggests strong local engagement in research and cardiovascular care.&#x0D; Research output significantly increased and the share of literature from major research contributors has relatively shrunk over the study period, which suggests emerging research capacities from previously underrepresented regions.&#x0D; A demographic analysis of publications showed that studies were set in countries from all income brackets, with the majority of the studies originating from low-income countries.&#x0D; There is a need to standardise reporting of surgical outcomes which is dependent on perioperative care and maintenance of high-quality health records.&#x0D; Over half of the publications lacked evidence of outpatient follow-up or data on postoperative care, which highlights the need to focus on patient outcomes as a metric.&#x0D;

Effect of Trema guineensis (Celtidaceae) on ethanol-induced hypertension in Wistar rats

Objective: Trema guineensis is a traditional medicinal plant used to treat cardiovascular diseases in Africa. Here, we evaluated the effects of its hydro-alcoholic leaves on ethanol-induced hypertension. Method: Four groups of five rats each were used in this study. Group I, the control group, received distilled water (10 ml kg-1), Group II received ethanol (35°) at 3 g/kg, and Groups III and IV received ethanol (35°) at 3 g/kg followed by 200 and 400 mg/kg extract, respectively. Ethanol solutions were administered over 8 weeks. Results: The ethanol solutions increased body weight, blood pressure, superoxide dismutase (SOD), and malondialdehyde (MDA), and reduced glutathione (GSH) and nitric oxide (NO). As for the hematological parameters, the ethanol solutions reduced hemoglobin, red blood cells, white blood cells, platelets, polymorphonuclear cells, and lymphocytes, as well as corpuscular volume compared with the control group. The T. guineensis extract significantly prevented increased body weight, blood pressure, SOD, MDA, GSH, and NO. The extract also normalized hematological parameters. Conclusion: These results suggest that this extract contains antihypertensive properties that protect against ethanol-induced hypertension.

Perspectives for the Prevention of Cardiovascular Disease in Africa: The Sousse' Declaration 2018.

Perspectives for the Prevention of Cardiovascular Disease in Africa: The Sousse' Declaration 2018.

Availability and utilization of electrocardiogram as cardiac diagnostic tool in private hospitals in Port Harcourt

Background: Electrocardiography is a low cost, easy to perform method of investigation of the cardiovascular system with diagnostic and prognostic value, and great clinical usefulness. There is an increasing prevalence of cardiovascular disease in Africa and other developing nations of the world. The private hospitals serve as the first port of call to a large number of cardiac patients. Hence, they need to determine the availability and utilization of electrocardiogram (ECG) in the private hospitals. Methodology: This is a cross-sectional, descriptive study involving medical practitioners who offer medical services in the private hospitals in Port Harcourt. A structured self-administered questionnaire was used in this study with a total of 120 analyzable data generated. Results: In this study, 72.5% of the respondents were male with females constituting 27.5%. Most of the respondents were general practitioners and mostly Conclusion: There are good availability and utilization of ECG facilities among private practitioners in Port Harcourt. The knowledge and competence for interpretation of ECG are poor. There is, therefore, a need for formal training in ECG interpretation for general and private medical practitioners in Port Harcourt, Nigeria.

Effect of Trema guineensis (celtidaceae) on ethanol-induced hypertension in Wistar rats.

Objective: Trema guineensis is a traditional medicinal plant used to treat cardiovascular diseases in Africa. Here, we evaluated the effects of its hydro-alcoholic leaves on ethanol-induced hypertension. Method: Four groups of five rats each were used in this study. Group I, the control group, received distilled water (10 mL kg-1), Group II received ethanol (35°) at 3 g/kg, and Groups III and IV received ethanol (35°) at 3 g/kg followed by 200 and 400 mg/kg extract respectively. Ethanol solutions were administered over eight weeks. Results: The ethanol solutions increased body weight, blood pressure, superoxide dismutase (SOD), and malondialdehyde (MDA), and reduced glutathione (GSH) and nitric oxide (NO). As for the hematological parameters, the ethanol solutions reduced hemoglobin (HB), red blood cells (RBCs), white blood cells (WBCs), platelets (PLTs), polymorphonuclear cells (PNs), and lymphocytes (LYs), as well as corpuscular volume (VGM) compared to the control group. The T. guineensis extract significantly prevented increased body weight, blood pressure, SOD, MDA, GSH, and NO. The extract also normalized hematological parameters. Conclusion: These results suggest that this extract contains antihypertensive properties that protect against against ethanol-induced hypertension.

The Pan-African Society of Cardiology position paper on reproductive healthcare for women with rheumatic heart disease.

This position paper summarises the current knowledge on the epidemiology, diagnosis and management of women of childbearing age with rheumatic heart disease (RHD) in Africa, as well as the available data on their use of reproductive health services. The aim is to provide guidance to health professionals on aspects of sexual and reproductive health in women with RHD. It reviews the diagnosis, management and counselling of women with RHD throughout their reproductive life. Additionally, this publication discusses potential ways of integrating obstetric and cardiovascular care at peripheral levels of the health systems, as a way of improving outcomes and reducing maternal mortality rates related to cardiovascular disease in Africa. Finally, the article proposes responses to fulfil the actual needs for better reproductive health services and improvement in care for women with RHD.

Genetic Determinants of Dyslipidemia in African-Based Populations: A Systematic Review.

Identification of genetic/genomic factors contributing to dyslipidemia is of great interest to prevention and reduction of the onset and burden of cardiovascular diseases in Africa. This systematic review summarizes available data on genetic variants associated with dyslipidemia in populations within Africa. A PubMed and EMBASE database search was conducted to identify all studies published until June 2018 on genetic susceptibility to dyslipidemia in African-based populations, excluding familial hypercholesterolemia. All studies on genetic predispositions of dyslipidemia and respecting the preestablished inclusion criteria were included in this systematic review. Because of high heterogeneity, the data were summarized narratively. Twenty-two studies investigated mostly the targeted genetic variants. A total of 51 polymorphisms in 28 susceptibility genes to dyslipidemia have been associated with a particular trait in the African populations, and through variable effects. Most polymorphisms investigated in Northern Africa seemed to have consistent effects on increasing the level of low-density lipoprotein cholesterol (LDL-C), total cholesterol, and triglycerides in patients with diabetes, myocardial infarction, coronary artery disease, and metabolic syndrome. By contrast, only Ser447Ter and C49620T variants were associated with increased LDL-C in sub-Saharan Africa. Despite few studies available in this context in the literature, certain genetic variants were consistently associated with dyslipidemia especially in Northern Africa as highlighted in this analysis. Further data, particularly from genome-wide association studies, would help establish an African-specific reference for genetic susceptibility markers of dyslipidemia.

HIV metabolic clinic: can the journey start from a UK clinic to a sub-Saharan African nation?

As a result of effective treatment and care, the HIV population is living longer and facing the issues of ageing, which in turn will present the challenges of dealing with an increased prevalence of dyslipidemia, diabetes, metabolic syndrome (MetS) and nonalcoholic fatty liver disease (NAFLD). Combination antiretroviral therapy (cART) decreases mortality and morbidity in HIV patients, but can leads to an increase incidence of in insulin resistance, dyslipidemia, abnormalities of fat distribution and higher risk of cardiovascular disease (CVD). Therefore, a metabolic clinic was established for individuals living with HIV in the Milton Keynes University Hospital (MKUH) NHS Foundation Trust in 2014 to provide a focus on these issues and involve specialised care in a multi-disciplinary type care to avoid expensive community care. In this review, we will argue the need to replicate such a model of care the metabolic clinic in sub-Saharan African (SSA) where the burden of HIV is high. An extensive search and analysis was carried out using PubMed and Google scholar published-English literature since 1996 were critically reviewed. The peak prevalence of diagnosed diabetes mellitus (DM) in HIV infection for SSA can be as high as 26.5%, prediabetes 43.5%, MetS 58% and dyslipidemia 70%. Also, HIV-associated nephropathy (HIVAN) in Africa is estimated to affect around 35–70%. These factors (diabetes, dyslipidaemia, and nephropathy) may predict an increase in CVD in Africa. Therefore, there is an urgent need to manage these complex factors and CVD in specialized metabolic clinics in African countries. We are aware the cost of establishing and running metabolic clinic may add more financial strain to potentially the under-resourced health care systems in SSA but this may be cost effective in the long run. Importantly, our experience suggests that metabolic clinic is beneficial to patients and staff and should be an essential part of HIV services especially as our ageing HIV population is increasing. This will come with the benefit of not only managing CVD and developing strategies to deal with the epidemic of diabetes but also with establishing research and clinical trials, in such diverse populations in Africa.