Descriptive Epidemiology of Cardiovascular Risk Factors and Diabetes in Sub-Saharan Africa
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.
References (45)
- et al.
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study
Lancet
(2004) - et al.
A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants
Lancet
(2011) - et al.
National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants
Lancet
(2011) - et al.
National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants
Lancet
(2011) - et al.
National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants
Lancet
(2011) - et al.
Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
Diabetes in sub-Saharan Africa
Lancet
(2010)
The burden of non-communicable diseases in South Africa
Lancet
The burden of hypertension and its risk factors in Malawi: nationwide population-based STEPS survey
Int Health
Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
Factors of risk in the development of coronary heart disease – six year follow-up experience. The Framingham Study
Ann Intern Med
Risk factors associated with myocardial infarction in Africa: the INTERHEART Africa study
Circulation
National, regional, and global trends in adult overweight and obesity prevalences
Popul Health Metrics
The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008
Circulation
Urbanisation, nutrition transition and cardiometabolic risk: the Benin study
Br J Nutr
Social drift of cardiovascular disease risk factors in Africans from the North West Province of South Africa: the PURE study
Cardiovasc J South Afr
Urbanization, ethnicity and cardiovascular risk in a population in transition in Nakuru, Kenya: a population-based survey
BMC Public Health
Cardiovascular disease risk factors and socio-economic position of Africans in transition: the THUSA study
Cardiovasc J South Afr
Diabetes in Africa: the situation in the Seychelles
Heart
Cited by (46)
The global burden of disease attributable to metabolic risks in 204 countries and territories from 1990 to 2019
2023, Diabetes Research and Clinical PracticeAssessment of cardiovascular disease risks using Framingham risk scores (FRS) in HIV-positive and HIV-negative older adults in South Africa
2021, Preventive Medicine ReportsCitation Excerpt :Of these factors, it was shown in a study among HIV-positive adults in Taiwan that a smoking cessation intervention could potentially result in 20 to 35% reduction in the 10-year risk of CVD (Wu et al., 2019). In South Africa, a key driver of the increasing cardio-metabolic disorders is obesity (Mensah, 2013). However, it is yet to be determined what the effect of an obesity reduction intervention would be on cardiovascular morbidity and mortality in the country.
Finnish diabetes risk score for type 2 diabetes and risk factors in a student environment in Burkina Faso
2019, Medecine des Maladies MetaboliquesTraining in Cardiovascular Epidemiology and Prevention: A 50-Year Journey From Makarska to Goa
2018, Global HeartCitation Excerpt :However, the progress seen was only rarely linked to regional postgraduate training programs in epidemiology [29]. The importance of this challenge and the need for increased training in cardiovascular epidemiology and prevention is highlighted by the rising burden of high blood pressure and cardiometabolic diseases in this region [34]. This challenge is not unique to sub-Saharan Africa but is seen in many low-resource settings in low- and middle-income countries [35,36].
Using MutPred derived mtDNA load scores to evaluate mtDNA variation in hypertension and diabetes in a two-population cohort: The SABPA study
2017, Journal of Genetics and GenomicsCitation Excerpt :For blood glucose measurements (% of HbA1c) haplogroup L males had significantly higher values than both male and female groups from haplogroup MN (P < 0.0001), and only slightly higher values than haplogroup L females (P = 0.03); haplogroup L females had significantly higher blood glucose levels than their haplogroup MN counterparts (P = 0.0004) (Fig. 1). These differences have been previously reported in the current cohort (Lammertyn et al., 2011; Hamer et al., 2015), and correlates well with similar discrepancies between population groups reported in other studies (reviewed by Mensah, 2013). Consequently, data were divided into four groups based on gender and mtDNA background and analysed separately for subsequent analysis.
Statement of Conflict of Interest: see page: 248.
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.