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

• Published in: BMC medicine 2021-02, Vol.19 (1), p.30-30, Article 30
• Main Authors: Nonterah, Engelbert A, Crowther, Nigel J, Oduro, Abraham, Agongo, Godfred, Micklesfield, Lisa K, Boua, Palwendé R, Choma, Solomon S R, Mohamed, Shukri F, Sorgho, Herman, Tollman, Stephen M, Norris, Shane A, Raal, Frederick J, Grobbee, Diederick E, Ramsay, Michelé, Bots, Michiel L, Klipstein-Grobusch, Kerstin
• Format: Article
• Language: English
• Subjects: Arteries; Arteriosclerosis; Atherosclerosis; Blood pressure; Body mass; Body mass index; Body size; Cardiovascular diseases; Cardiovascular health index; Carotid arteries; Carotid artery; Carotid intima-media thickness; Cholesterol; Confidence intervals; Demographic aspects; Development and progression; Diagnosis; Diet; Dietary intake; Economic analysis; Education; Food intake; Generalized linear models; Glucose; Health risks; HIV; Households; Human immunodeficiency virus; Hyperglycemia; Hypertension; Laboratories; Men; Obesity; Physical activity; Population; Population studies; Populations; Primary prevention; Principal components analysis; Public health; Regression analysis; Risk analysis; Risk factors; Smoking; Socioeconomic factors; Socioeconomics; Statistical analysis; Sub-Saharan Africa; Subclinical atherosclerosis; Thickness; Variables; Veins & arteries; Women; Womens health
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-021-01909-6

The cardiovascular health index (CVHI) introduced by the American Heart Association is a valid, accessible, simple, and translatable metric for monitoring cardiovascular health in a population. Components of the CVHI include the following seven cardiovascular risk factors (often captured as life's simple 7): smoking, dietary intake, physical activity, body mass index, blood pressure, glucose, and total cholesterol. We sought to expand the evidence for its utility to under-studied populations in sub-Saharan Africa, by determining its association with common carotid intima-media thickness (CIMT). We conducted a cross-sectional study involving 9011 participants drawn from Burkina Faso, Ghana, Kenya, and South Africa. We assessed established classical cardiovascular risk factors and measured carotid intima-media thickness of the left and right common carotid arteries using B-mode ultrasonography. Adjusted multilevel mixed-effect linear regression was used to determine the association of CVHI with common CIMT. In the combined population, an individual participant data meta-analyses random-effects was used to conduct pooled comparative sub-group analyses for differences between countries, sex, and socio-economic status. The mean age of the study population was 51 ± 7 years and 51% were women, with a mean common CIMT of 637 ± 117 μm and CVHI score of 10.3 ± 2.0. Inverse associations were found between CVHI and common CIMT (β-coefficients [95% confidence interval]: Burkina Faso, - 6.51 [- 9.83, - 3.20] μm; Ghana, - 5.42 [- 8.90, - 1.95]; Kenya, - 6.58 [- 9.05, - 4.10]; and South Africa, - 7.85 [- 9.65, - 6.05]). Inverse relations were observed for women (- 4.44 [- 6.23, - 2.65]) and men (- 6.27 [- 7.91, - 4.64]) in the pooled sample. Smoking (p