Spectrum of heart disease and risk factors in a black urban population in South Africa (the Heart of Soweto Study): a cohort study

Sliwa, Karen; Wilkinson, David; Hansen, Claus D.; Ntyintyane, Lucas; Tibazarwa, Kemi; Becker, A.; Stewart, Simon

doi:10.1016/s0140-6736(08)60417-1

Cited by 341 publications

(286 citation statements)

References 17 publications

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“…This high burden of CVD risk is troubling, given the relatively young age of the participants; nearly 30% were aged <45 years, and 94% were aged <65 years. The majority of CVD deaths in sub‐Saharan Africa occur among persons aged between 30 and 69 years, a range that is 10 years younger than the equivalent age group in Europe and the United States 34, 35. Consequently, WAI in the United States may be at high risk for CVD events at a younger age; however, there are currently no data on CVD events in WAI in the United States to support our assertion.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Cardiovascular Disease Risk of Ghanaian‐ and Nigerian‐Born West African Immigrants in the United States: The Afro‐Cardiac Study

Commodore-Mensah

Hill

Allen

et al. 2016

JAHA

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BackgroundThe number of African immigrants in the United States grew 40‐fold between 1960 and 2007, from 35 355 to 1.4 million, with a large majority from West Africa. This study sought to examine the prevalence of cardiovascular disease (CVD) risk factors and global CVD risk and to identify independent predictors of increased CVD risk among West African immigrants in the United States.Methods and ResultsThis cross‐sectional study assessed West African (Ghanaian and Nigerian) immigrants aged 35–74 years in the Baltimore–Washington metropolitan area. The mean age of participants was 49.5±9.2 years, and 58% were female. The majority (95%) had ≥1 of the 6 CVD risk factors. Smoking was least prevalent, and overweight or obesity was most prevalent, with 88% having a body mass index (in kg/m2) ≥25; 16% had a prior diagnosis of diabetes or had fasting blood glucose levels ≥126 mg/dL. In addition, 44% were physically inactive. Among women, employment and health insurance were associated with odds of 0.09 (95% CI 0.033–0.29) and 0.25 (95% CI 0.09–0.67), respectively, of having a Pooled Cohort Equations estimate ≥7.5% in the multivariable logistic regression analysis. Among men, higher social support was associated with 0.90 (95% CI 0.83–0.98) lower odds of having ≥3 CVD risk factors but not with having a Pooled Cohort Equations estimate ≥7.5%.ConclusionsThe prevalence of CVD risk factors among West African immigrants was particularly high. Being employed and having health insurance were associated with lower CVD risk in women, but only higher social support was associated with lower CVD risk in men.

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Section: Discussionmentioning

confidence: 99%

Sex Differences in Cardiovascular Disease Risk of Ghanaian‐ and Nigerian‐Born West African Immigrants in the United States: The Afro‐Cardiac Study

Commodore-Mensah

Hill

Allen

et al. 2016

JAHA

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“…Worldwide, various forms of cardiovascular involvement, such as endothelial dysfunction,3 accelerated atherosclerosis4 and coagulation disorders5 have been documented among HIV-infected individuals. In South Africa, atherosclerotic disease, historically not common in most black Africans, is increasing 6. One of the important contributors, at least in part, to this increase could be the cardiac complications related to HIV infection, as South Africa is the country with the highest number of HIV infections in the world 7…”

Section: Introductionmentioning

confidence: 99%

Is HIV-1 infection associated with endothelial dysfunction in a population of African ancestry in South Africa?

Fourie¹,

Rooyen²,

Pieters³

et al. 2011

CardioVascular Journal of Africa

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The chronic infection status suffered by HIV-infected individuals promotes chronic arterial inflammation and injury, which leads to dysfunction of the endothelium, atherosclerosis and thrombosis. Although HIV-1 subtype C is prevalent in South Africa and accounts for almost a third of the infections worldwide, this subtype differs genetically from HIV-1 subtype B on which the majority of studies have been done. The objective of this study was to assess whether newly identified, never-treated, HIV-1-infected South African participants showed signs of endothelial dysfunction, accelerated atherosclerosis and increased blood coagulation.We compared 300 newly diagnosed (never antiretroviral-treated) HIV-infected participants to 300 age-, gender-, body mass index- and locality-matched uninfected controls. Levels of high-density lipoprotein cholesterol (HDL-C), triglycerides, interleukin-6 (IL-6), C-reactive protein (CRP), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), fibrinogen and plasminogen activator inhibitor-1 (PAI-1), and carotid radialis pulse wave velocity (cr-PWV) were determined. The HIV-infected participants showed lower HDL-C and higher IL-6, CRP, ICAM-1 and VCAM-1 levels compared to the uninfected controls. No differences in fibrinogen and PAI-1 levels were detected. A continuous positive trend of increasing age with cr-PWV was detected in the HIV-infected group.Our findings suggest inflammatory injury of the endothelium, pointing to endothelial dysfunction of never-treated HIV-1-infected South Africans of African ancestry. Although no indication of a prothrombotic state could be detected, there was an indication of accelerated vascular aging and probable early atherosclerosis in the older HIV-infected participants.

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“…A better understanding of the underlying mechanisms is essential in preventive actions against CVD especially in developing countries such as South Africa, which suffers from a high prevalence of CVD. 15,16 African men are considered to be a high-risk group for the development of hypertension in South Africa, 15,16 and it is essential to identify risk factors contributing to their high susceptibility of CVD. In a study by Fang and Alderman, 4 it was found that men had significantly higher UA levels than women.…”

Section: Introductionmentioning

confidence: 99%

Uric acid and the cardiovascular profile of African and Caucasian men

2010

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The African population is considered a high-risk group for the development of hypertension, and identifying risk factors are therefore essential in preventive actions against cardiovascular disease (CVD). Elevated levels of uric acid (UA) are often associated with CVD. Our first aim was to establish possible ethnic differences in UA levels between African and Caucasian men. Our second aim was to determine any associations between UA levels and cardio-metabolic variables, and also how these correlates differ between the two groups. African (N ¼ 87) and Caucasian (N ¼ 121) men participated in this cross-sectional study. Our results have shown that African men had significantly lower (353±87.7 vs 401 ± 98.2; Po0.01) UA levels compared with Caucasian men. Waist circumference and triglycerides correlated strongly with UA in both ethnic groups. This was confirmed with a forward stepwise multiple regression analysis. After adjustment for confounders, the correlation between UA and triglycerides remained significant only in the Caucasians (r ¼ 0.29; P ¼ 0.02), whereas only the African men showed an independent correlation between UA and total peripheral resistance (TPR) (r ¼ 0.23; P ¼ 0.04). TPR increased significantly across UA tertiles only in the African men (P ¼ 0.01 vs P ¼ 0.96).In conclusion, despite their lower UA levels, Africans showed an independent relationship between UA and vascular resistance, indicating a possible explanation for their high prevalence of hypertension.

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Spectrum of heart disease and risk factors in a black urban population in South Africa (the Heart of Soweto Study): a cohort study

Cited by 341 publications

References 17 publications

Sex Differences in Cardiovascular Disease Risk of Ghanaian‐ and Nigerian‐Born West African Immigrants in the United States: The Afro‐Cardiac Study

Sex Differences in Cardiovascular Disease Risk of Ghanaian‐ and Nigerian‐Born West African Immigrants in the United States: The Afro‐Cardiac Study

Is HIV-1 infection associated with endothelial dysfunction in a population of African ancestry in South Africa?

Uric acid and the cardiovascular profile of African and Caucasian men

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