Cardiovascular risk factor burden in Africa and the Middle East: the Africa Middle East Cardiovascular Epidemiological (ACE) study

PLoS One. 2014 Aug 4;9(8):e102830. doi: 10.1371/journal.pone.0102830. eCollection 2014.

Abstract

Background: Increased urbanization in the developing world parallels a rising burden of chronic diseases. Developing countries account for ∼ 80% of global cardiovascular (CV) deaths, but contribute a paucity of systematic epidemiological data on CV risk factors.

Objective: To estimate the prevalence of CV risk factors in rural and urban cohorts attending general practice clinics in the Africa and Middle East (AfME) region.

Methods: In a cross-sectional epidemiological study, the presence of CV risk factors (hypertension, diabetes mellitus (diabetes), dyslipidemia, obesity, smoking and abdominal obesity) were evaluated in stable adult outpatients attending general practice primary care clinics. A rural population was defined as isolated (>50 km or lack of easy access to commuter transportation) from urban centers.

Results: 4,378 outpatients were systematically recruited from 94 clinics across 14 AfME countries. Mean age was 46 ± 14 years and 52% of outpatients were female. A high prevalence of dyslipidemia (70%) and abdominal obesity (68%) were observed, followed by hypertension (43%) and diabetes (25%). The vast majority of outpatients (92%) had at least one modifiable CV risk factor, many (74%) had more than one, and half (53%) had 3 or more. These findings were observed in both genders and across urban and rural centers. Among outpatients with pre-existing hypertension or dyslipidemia, many were not at their target blood pressure or LDL-cholesterol goals.

Conclusion: Cardiovascular risk factors are highly prevalent among relatively young, stable outpatients attending general practice clinics across AfME. The findings support opportunistic screening for CV risk factors whenever outpatients visit a general practitioner and provide an opportunity for early identification and management of CV risk factors, including lifestyle interventions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Africa / epidemiology
  • Age Factors
  • Cardiovascular Diseases / epidemiology*
  • Cohort Studies
  • Cost of Illness*
  • Diabetes Mellitus / epidemiology
  • Dyslipidemias / epidemiology
  • Female
  • Humans
  • Hypertension / epidemiology
  • Male
  • Middle Aged
  • Middle East / epidemiology
  • Obesity / epidemiology
  • Outpatients
  • Prevalence
  • Residence Characteristics
  • Risk Factors
  • Sex Characteristics
  • Smoking / epidemiology

Grants and funding

This study was sponsored by Pfizer. Additional editorial support was provided by Steph Milsom at PHASE II International, Esher, Surrey, UK, and funded by Pfizer. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. Although Pfizer does not deposit clinical trial data into a publicly available resource, Pfizer makes every effort to provide access to clinical data via a data transfer agreement for researchers and investigators who wish to utilize the data to address medically relevant hypotheses. The authors, three of whom are employees at Pfizer, were involved in all aspects of the study design and implementation and we have stated the roles of each of the authors in the ‘Additional Information - Author Contributions’ section of the online form. All authors have contributed significantly to this work, and meet requirements for authorship in compliance with the International Committee of Medical Journal Editors guidelines. All listed authors have seen and approved the revised version submitted.