Distribution of a subclinical marker of cardiovascular risk, the ankle brachial index, in a rural African population: SASPI study

Fowkes, F. Gerry R.; Thorogood, Margaret; Connor, Myles; Lewando-Hundt, Gillian; Tzoulaki, Ioanna; Tollman, Stephen

doi:10.1097/01.hjr.0000201511.28590.9f

Cited by 30 publications

(26 citation statements)

References 25 publications

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“…These data accord with an anticipated increase in vascular non-communicable disease in younger age groups during transition. Despite fairly favourable cholesterol concentrations, there is evidence of subclinical peripheral atheroma in the study population, and adults 35 years and older had a distribution of the ankle brachial index which was similar to that noted in high-income populations with peripheral vascular disease 16 . Although sub-Saharan Africa is usually cited as a region in the earliest stage of epidemiological transition, 17 this risk and morbidity profile suggests a population in a later stage of transition, one that is typically dominated by hypertension-related disease.…”

Section: Discussionsupporting

confidence: 61%

Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study

Tollman¹,

Kahn²,

Sartorius³

et al. 2008

The Lancet

180

168

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SummaryBackgroundIn southern Africa, a substantial health transition is underway, with the heavy burden of chronic infectious illness (HIV/AIDS and tuberculosis) paralleled by the growing threat of non-communicable diseases. We investigated the extent and nature of this health transition and considered the implications for primary health care.MethodsHealth and sociodemographic surveillance started in the Agincourt subdistrict, rural South Africa, in 1992. In a population of 70 000, deaths (n=6153) were rigorously monitored with a validated verbal autopsy instrument to establish probable cause. We used age-standardised analyses to investigate the dynamics of the mortality transition by comparing the period 2002–05 with 1992–94.FindingsMortality from chronic non-communicable disease ranked highest in adults aged 50 years and older in 1992–94 (41% of deaths [123/298]), whereas acute diarrhoea and malnutrition accounted for 37% of deaths (59/158) in children younger than 5 years. Since then, all-cause mortality increased substantially (risk ratio 1·87 [95% CI 1·73–2·03]; p<0·0001) because of a six-fold rise in deaths from infectious disease affecting most age and sex groups (5·98 [4·85–7·38]; p<0·0001), and a modest increase in deaths from non-communicable disease (1·15 [0·99–1·33]; p=0·066). The change in female risk of death from HIV and tuberculosis (15·06 [8·88–27·76]; p<0·0001) was almost double that of the change in male risk (8·13 [5·55–12·36]; p<0·0001). The burden of disorders requiring chronic care increased disproportionately compared with that requiring acute care (2·63 [2·30–3·01]; p<0·0001 vs 1·31 [1·12–1·55]; p=0·0003).InterpretationMortality from non-communicable disease remains prominent despite the sustained increase in deaths from chronic infectious disease. The implications for primary health-care systems are substantial, with integrated chronic care based on scaled-up delivery of antiretroviral therapy needed to address this expanding burden.FundingThe Wellcome Trust, UK; University of the Witwatersrand, Medical Research Council, and Anglo American and De Beers Chairman's Fund, South Africa; the European Union; Andrew W Mellon Foundation, Henry J Kaiser Family Foundation, and National Institute on Aging, National Institutes of Health, USA.

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Section: Discussionsupporting

confidence: 61%

Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study

Tollman¹,

Kahn²,

Sartorius³

et al. 2008

The Lancet

180

168

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“…Lower ABI was related to current cigarette smoking ( P =.02) and higher systolic and diastolic BP levels ( P <.01 and P =.02, respectively) but not total cholesterol levels, which were relatively low in this population. The distribution of the ABI in this population is very similar to that reported in western populations 41 …”

Section: Lipids As a Risk Factor For Cms In Persons Of African Ancestrysupporting

confidence: 85%

The Cardiometabolic Syndrome in Persons of the African Diaspora: Challenges and Opportunities

Schuster

Gaillard

Osei

2007

J Cardiometabolic Synd

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Unique genetic traits appear to play a role in the increased rates of hypertension (HTN), glucose dysregulation/diabetes (T2DM), and obesity in persons of African descent. Indeed, with increasing rates of westernization/urbanization and concomitant increases in obesity and T2DM, a similar predisposition to the cardiometabolic syndrome and cardiovascular disease (CVD) can be seen in Africans compared with persons of African descent, with CVD reaching epidemic proportions in many areas of Africa. In addition, the complex relationships of metabolic abnormalities that are unique to individuals of African descent have also been demonstrated in Africans. These include: (1) a dissociation of HTN to insulin resistance; (2) relative favorable lipid profile in the setting of increasing rates of CVD; (3) low levels of visceral adiposity in the setting of obesity and insulin resistance; and (4) a dissociation of insulin sensitivity and adiponectin when compared with Caucasians. Although not well understood, these unique relationships suggest that conventional parameters for CVD do not apply to Africans of persons of African descent.

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“…However, the p value obtained indicated a consistent trend that the association between PAD and age range really existed. Studies that specifically evaluated the 36% 9,[15][16][17][18] whereas, in younger populations, as the one in the present study, the prevalence ranged from 3% to 16% [19][20][21][22][23][24] . In populations with high cardiovascular risk, it ranged from 29% to 40.5% 25,26 .…”

Section: Discussionmentioning

confidence: 87%

Prevalência e fatores de risco associados à doença arterial periférica no projeto corações do Brasil

Makdisse

Pereira

Brasil

et al. 2008

Arq. Bras. Cardiol.

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PAD prevalence was markedly high, considering the low mean age of the studied population (44+/-14.7 yrs). IC was detected in a minority of PAD subjects, indicating a considerable number of asymptomatic individuals. Diabetes, obesity, stroke and IHD were the stronger predictors of PAD. The authors concluded that ABI measurement should be considered in the evaluation of moderate to high cardiovascular risk patients.

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Distribution of a subclinical marker of cardiovascular risk, the ankle brachial index, in a rural African population: SASPI study

Cited by 30 publications

References 25 publications

Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study

Implications of mortality transition for primary health care in rural South Africa: a population-based surveillance study

The Cardiometabolic Syndrome in Persons of the African Diaspora: Challenges and Opportunities

Prevalência e fatores de risco associados à doença arterial periférica no projeto corações do Brasil

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