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. 2019 Jul 16;8(14):e011506.
doi: 10.1161/JAHA.118.011506. Epub 2019 Jul 13.

Classical Cardiovascular Risk Factors and HIV are Associated With Carotid Intima-Media Thickness in Adults From Sub-Saharan Africa: Findings From H3Africa AWI-Gen Study

Engelbert A Nonterah  1   2 , Palwende R Boua  3   4   5 , Kerstin Klipstein-Grobusch  2   6 , Gershim Asiki  7 , Lisa K Micklesfield  8 , Godfred Agongo  1 , Stuart A Ali  4 , Felistas Mashinya  9 , Herman Sorgho  3 , Seydou Nakanabo-Diallo  3 , Cornelius Debpuur  1 , Catherine Kyobutungi  7 , Marianne Alberts  9 , Shane Norris  8 , Stephen Tollman  6   10   11 , Halidou Tinto  3 , Cassandra C Soo  4   5 , Freedom Mukomana  4 , Scott Hazelhurst  4 , Alisha N Wade  10 , Kathleen Kahn  6   10   11 , Abraham R Oduro  1 , Diederick E Grobbee  2 , Osman Sankoh  6   11 , Michèle Ramsay  4   5 , Michiel L Bots  2 , Nigel J Crowther  12 ; as members and collaborators of AWI‐Gen and the H3Africa Consortium
Affiliations

Classical Cardiovascular Risk Factors and HIV are Associated With Carotid Intima-Media Thickness in Adults From Sub-Saharan Africa: Findings From H3Africa AWI-Gen Study

Engelbert A Nonterah et al. J Am Heart Assoc. .

Abstract

Background Studies on the determinants of carotid intima-media thickness ( CIMT ), a marker of sub-clinical atherosclerosis, mostly come from white, Asian, and diasporan black populations. We present CIMT data from sub-Saharan Africa, which is experiencing a rising burden of cardiovascular diseases and infectious diseases. Methods and Results The H3 (Human Hereditary and Health) in Africa's AWI-Gen (African-Wits-INDEPTH partnership for Genomic) study is a cross-sectional study conducted in adults aged 40 to 60 years from Burkina Faso, Kenya, Ghana, and South Africa. Cardiovascular disease risk and ultrasonography of the CIMT of right and left common carotids were measured. Multivariable linear and mixed-effect multilevel regression modeling was applied to determine factors related to CIMT. Data included 8872 adults (50.8% men), mean age of 50±6 years with age- and sex-adjusted mean (±SE) CIMT of 640±123μm. Participants from Ghana and Burkina Faso had higher CIMT compared with other sites. Age (β = 6.77, 95%CI [6.34-7.19]), body mass index (17.6[12.5-22.8]), systolic blood pressure (7.52[6.21-8.83]), low-density lipoprotein cholesterol (5.08[2.10-8.06]) and men (10.3[4.75- 15.9]) were associated with higher CIMT. Smoking was associated with higher CIMT in men. High-density lipoprotein cholesterol (-12.2 [-17.9- -6.41]), alcohol consumption (-13.5 [-19.1--7.91]) and HIV (-8.86 [-15.7--2.03]) were inversely associated with CIMT. Conclusions Given the rising prevalence of cardiovascular diseases risk factors in sub-Saharan Africa, atherosclerotic diseases may become a major pan-African epidemic unless preventive measures are taken particularly for prevention of hypertension, obesity, and smoking. HIV -specific studies are needed to fully understand the association between HIV and CIMT in sub-Saharan Africa.

Keywords: cardiovascular disease; carotid intima‐media thickness; epidemiological transition; prevention; sub‐Saharan Africa.

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Figures

Figure 1
Figure 1
The sites constituting the H3Africa AWI‐Gen study. Reprinted from Ramsay et al13 with permission. Copyright ©2016, Cambridge University Press.
Figure 2
Figure 2
Age‐ and sex‐adjusted distribution of mean levels of common CIMT (in mm) across 4 SSA countries stratified by sex. Differences between women (W) and men (M) were generated using sample t‐test with equal variance; *Data not available for women in Soweto. CIMT indicates carotid intima‐media thickness; SSA, sub‐Saharan Africa.
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