Disparities in Management of Cardiovascular Disease in Rural South Africa

Abstract

Background Optimal secondary prevention is critical for the reduction of repeated cardiovascular events and the control of cardiovascular risk factors in this context is essential. Data on secondary prevention of cardiovascular disease (CVD) in sub-Saharan Africa are needed to inform intervention strategies, with a particular focus on local disparities. The aim of this study was to assess CVD management in a rural community in northeast South Africa. Methods and Results We recruited adults aged ≥ 40 years residing in the Agincourt sub-district of Mpumalanga province. Data collection included socioeconomic and clinical data, anthropometric measures, blood pressure, HIV status and point-of-care glucose and lipid levels. CVD was defined as self-report of myocardial infarction and stroke, or angina diagnosed by Rose Criteria. A linear regression model was built to identify variables independently associated with the number of cardiovascular risk factors controlled. Out of 5,059 subjects, 592 (11.7%) met CVD diagnostic criteria. Angina was reported in 77.0% of these subjects, stroke in 25.2% and myocardial infarction in 3.7%. Percent controlled of the five individual risk factors assessed were as follows: tobacco 92.9%; blood pressure 51.2%; BMI 33.8%; LDL 31.4%; and waist-to-hip ratio 29.7%. Only 4.4% had all five risk factors controlled and 42.4% had three or more risk factors controlled. Male sex (β-coefficient=0.44; 95%CI 0.25–0.63; p<0.001), absence of physical disability (β-coefficient=0.40; 95%CI 0.16–0.65; p=0.001) and socioeconomic status (SES) (β-coefficient=0.10; 95%CI 0.01–0.19; p=0.035) were directly associated with the number of risk factors controlled. Conclusions Currently, CVD is not being optimally managed in this rural area of South Africa. There are significant disparities in control of CVD risk factors by sex, SES, and level of disability. Efforts to improve secondary prevention in this population should be focused on females, subjects from lower SES, and those with physical disabilities.

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