Elsevier

Progress in Cardiovascular Diseases

Volume 56, Issue 3, November–December 2013, Pages 240-250
Progress in Cardiovascular Diseases

Descriptive Epidemiology of Cardiovascular Risk Factors and Diabetes in Sub-Saharan Africa

https://doi.org/10.1016/j.pcad.2013.10.014Get rights and content

Abstract

Reliable data on risk factor levels, exposure history, and population distribution can help inform policies and programs for disease prevention and control. With rare exception however, ideal local data on major risk factors and causes of death and disease burden have been scarce in sub-Saharan Africa (SSA). Basic community surveys in some countries and recent systematic analysis of disease burden attributable to 67 risk factors and risk factor clusters in 21 regions of the world provide an opportunity to examine and relate diabetes and cardiovascular risk factors to mortality and burden in SSA. Rising body mass index, especially in women in Southern Africa; and rising systolic blood pressure in East Africa for both sexes, and in West Africa for women are the major cardiometabolic risk factors. Harmful use of alcohol, especially in Southern SSA, tobacco use, and physical inactivity are also important. Improving vital registration and risk factor surveillance remain major challenges.

Section snippets

CVD risk factors in sub-Saharan Africa – the background

A high prevalence of adverse CHD risk factors in the nineteenth and early twentieth centuries in SSA seems very unlikely given the rarity of CHD in the published historical data from western, eastern, central, and southern Africa from that period.22 For example, extensive review of the Annual Medical and Sanitary Reports sent regularly to the Colonial Secretary in London by the Nigerian and Gold Coast governments showed that coronary heart disease was distinctly rare from 1898 to 1960.23., 24.,

The WHO stepwise approach to chronic disease risk factor surveillance (STEPS)

The WHO stepwise approach to chronic disease risk factor surveillance (STEPS) focuses on obtaining core data on the established risk factors that underlie the major chronic disease burden.32 It was intentionally designed with the flexibility to permit each country to obtain the core variables and risk factors, and to expand to include optional modules based on country interest and need.32 Most importantly, the use of the same standardized questions and protocols by all participating countries

The metabolic risk factors of chronic diseases

The Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group recently published prevalence data and trends at the national, regional, and global levels for body mass index5 and adult overweight and obesity;6 fasting plasma glucose and diabetes;7 serum total cholesterol;8 and systolic blood pressure.9 The data represent up to 960 country-years and over 9.1 million men and women over age 20 years who participated in national health examination surveys and epidemiological

The Global Burden of Diseases, Injuries, and Risk Factor (GBD 2010) Study

The GBD 2010 Study estimated deaths and disability-adjusted life years (DALYs) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010.4 At the global level in 2010, the three leading risk factors for disease burden were high blood pressure, tobacco smoking including second-hand smoke, and household air pollution from solid fuels.4 For SSA as a whole, the leading risk factors for disease burden remained those associated with

Implications for clinical and public health action

It is often stated that non-communicable diseases are the leading cause of death worldwide and that nearly 80% of these deaths in both men and women occur in low- and middle-income countries.35 Additionally, more than 80% of global cardiovascular and diabetes related deaths also occur in low- and middle income countries.35 More importantly, the World Health Organization has estimated that the largest increase in non-communicable disease-related mortality over the next decade will also occur in

Conclusions

Most communities in sub-Saharan Africa, except for those in South Africa and the island nations of Mauritius and Seychelles, are in the early phase of the epidemiological transition, where communicable diseases and famine are the predominant causes of mortality and disability. Nonetheless, there is mounting evidence that risk factors for CVD, diabetes, and other chronic NCDs are increasing in these communities. These risk factors in general, are not yet major contributors to the leading causes

Statement of Conflict of Interest

All authors declare that there are no conflict of interest.

Acknowledgments

I thank Professor Majid Ezzati for providing me access to the data from the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group; and Professor Mohsen Naghavi, Dr. Mohammed Faroufanzar, and Brittany Wurz of the Institute for Health Metrics and Evaluation for assistance with figures from the Global Burden of Diseases, Injuries, and Risk Factors (GBD 2010) Study.

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    Disclaimer: The views expressed in this article do not necessarily represent the views of the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services or any other government entity.

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