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

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

Alawi A Alsheikh-Ali  1 , Mohamed I Omar  2 , Frederick J Raal  3 , Wafa Rashed  4 , Omar Hamoui  5 , Abdoul Kane  6 , Mohamed Alami  7 , Paula Abreu  8 , Walid M Mashhoud  9
Affiliations

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

Alawi A Alsheikh-Ali et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: Mohamed I. Omar, Paula Abreu, and Walid Mashhoud are employees at Pfizer. Mohamed Alami has received honoraria from Novartis, Merck Sharpe & Dohme, Boehringer Ingelheim, Menarini, Actelion, Pfizer, and AstraZeneca. Alawi A. Alsheikh-Ali receives research support from Medtronic, and honoraria for CME activities from Boehringer Ingelheim, Pfizer, and Medtronic. Frederick Raal has received research grants, honoraria, or consulting fees for professional input and/or delivered lectures from AstraZeneca, Pfizer, Merck, Sanofi/Regeneron and Amgen. Omar Hamoui is a member of advisory boards, and has received speaking honoraria, from Pfizer, AstraZeneca, Boehringer Ingelheim, Novartis, Servier, Eli Lilly, Takeda, Merck Sharpe & Dohme, and Menirini. Abdoul Kane has received honoraria from Sanofi, Ajanta Pharma, Pfizer, and AstraZeneca for delivered lectures. Wafa Rashed does not have any conflicts of interest. 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.

Figures

Figure 1
Figure 1. Proportion of outpatients presenting with one or more cardiovascular risk factors.
Graph to show the percentage of outpatients presenting with 1–6 CV risk factors. Risk factors: dyslipidemia prevalence, hypertension prevalence, obesity (defined by BMI ≥30 kg/m2) prevalence, abdominal obesity prevalence, diabetes prevalence, and smoking prevalence.
Figure 2
Figure 2. Overall prevalence of cardiovascular risk factors across all participating countries.
Graph to show the overall prevalence and standard error of dyslipidemia, hypertension, obesity (defined by BMI ≥30 kg/m2), abdominal obesity, diabetes, and smoking across the AfME region.
Figure 3
Figure 3. Prevalence data and standard error per participating country.
Graphs depicting (A) dyslipidemia prevalence, (B) hypertension prevalence, (C) obesity (defined by BMI ≥30 kg/m2) prevalence, (D) abdominal obesity prevalence, (E) diabetes prevalence, and (F) smoking prevalence. Overall prevalence is shown by a solid line.
Figure 4
Figure 4. Overall cohort prevalence per investigated cardiovascular risk factor.
Graphs to show the difference in total cohort prevalence data for each risk factor (dyslipidemia, hypertension, diabetes, obesity (defined by BMI ≥30 kg/m2), abdominal obesity, and smoking) by (A) age, (B) gender, and (C) location.
See this image and copyright information in PMC

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