Cardiovascular Journal of Africa: Vol 28 No 3 (May/June 2017)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017

152

AFRICA

was noted among the hypertensive subjects, compared to 10% in

non-hypertensives. This was half that reported in Ghana among

hypertensive subjects,

although higher than the 13.5% reported

in Cameroon.

Hypertensive patients were also more likely to

be overweight and obese than non-hypertensive subjects, with

prevalence rates of 33.1 and 42.8%, compared to 30.5 and 16.8%,

respectively.

All other studied risk factors, such as hypercholesterolaemia,

abdominal adiposity (WC

88 cm for women and 102 cm for

men), and excessive alcohol consumption were more prevalent

among hypertensive subjects, except for smoking. The high

prevalence of cardiometabolic risk factors reported in our study

is similar to reports by Akintunde

et al

. among university staff

in Nigeria.

Besides factors such as a high-salt diet, low physical

activity and high socio-economic status (not examined in our

study), these are established risk factors for hypertension, which

in itself is a major risk for CVD. Urbanisation, among other

determinants, has largely been queried.

8,19,29

Our study showed that all risk factors studied were most

prevalent among participants with diabetes. About three out

of four diabetic subjects had hypertension. Other studies have

reported a high prevalence of high blood pressure among diabetic

subjects in Cameroon

and Tanzani,

although lower than in ours.

The higher prevalence of overweight, obesity (abdominal and

general)asreflectedinWCandmeanBMI,hypercholesterolaemia,

alcohol abuse and smoking, being more common in diabetic than

non-diabetic subjects, is however an expected finding, as they all

have individual and associative effects in predisposition to the

development of diabetes.

8,30

Therefore, while diabetes in itself

has been demonstrated to be an independent cardiovascular risk

factor,

the impact of its association or cumulative effect with

other traditional risk factors in the development, progression,

morbidity and mortality linked with CVDs cannot be over-

emphasised.

Limitations and strengths of the study

Our study has several limitations that deserve mention. First the

hospital base of the recruitments and the selected nature of the

participants could have increased the chances that those included

were at high risk for metabolic risk factors, which therefore could

account for the high prevalence of cardiometabolic risk factors

in our study. Secondly, the method of diagnosis of hypertension

could be subject to debate, but it has been clearly evidenced by

Burgess

et al.

that failure to carry out multiple measurements

to confirm the diagnosis may lead to false positives.

Thirdly,

quantity or concentration of alcohol in the local beer may

vary from one country to another, and we could not assess

non-industrial alcoholic beverages. Lastly, although the overall

sample size was large, the number of patients contributed from

each participating centre within the countries tended to be small,

therefore precluding meaningful centre-level analysis.

In spite of these limitations, the multi-centre, multi-national

character of this study increased our chances of adequately

exploring the prevalence of cardiometabolic risk factors in the

participating countries, and demonstrating evidence of the

growing cardiovascular risk factors in this region plagued with

communicable diseases. The use of well-trained data collectors

(medical practitioners) also gave confidence in the measured

parameters.

Conclusions

This study reports alarminglyhighprevalences of cardiometabolic

risk factors among adults presenting at urban and semi-urban

hospitals in selected countries in SSA, which is in line with IDF

projections of NCDs (hypertension and diabetes mellitus) in

the region. It also raises the question of the influence of rapid

urbanisation on the development of risk factors for imminent

cardiovascular and metabolic diseases. This has considerable

public health impact for an already economically disadvantaged

setting to design new methods or further strengthen existing

measures and interventions for the control of chronic diseases

in the region.

We thank all the investigators who participated in data acquisition: from

Madagascar: Rakotoarisoa Bodosoa, Raharimanana Lanto, Rakotoarimanana

Jean Jacques, Ratavilahy Roland, Andrianandrasana Hery, Rabarijoelina

Claude, Rakotoarisoa Holiarivelo, Johanes Abel, Rakotoniaina Beatrice,

Razafindramiandra Jacky, Raheliarisoa Julia, Rabetrano Alice, Rasolonjatovo

Methouchael, Miandrisoa Rija Mikhael, Rakotozafy Joseline, Raveloarison

Marguerite, Ramiandrisoa Bodovololona, Randriamiarisoa Ny Aina,

Raniriharisoa Voahirana, Rasolofomanana Ndrina, Rasamimanana Nivo

Nirina and Randriantsoa Eric; from Cameroon: Nzundu Anne, Mfulu Papy,

Mumbulu Erick, Christian Nsimba Luzolo, Mr Boderal Fundu, Tswakata

Masam, Iwnga Kabenba, Lepica Bonpeka, Murielle Longokolo, Tondo,

Bandubola Dedie, Kahamba Jean Louis, Massamba Mp Cla, Loshisha-Armod,

Bhuvem, Nzambi Mpvngv Stephane, Jimm Pierre K and Toure Wenana

Parfait; from the Democratic Republic of Congo: Toko Olivier, Nzundu Annie,

Tswakata Masam, Musibisoli Dieudonne, Longokolo Mireille, Bandubola

Dedie, Kahamba Jean-Louis, Massamba Mpela and Loshisha Arnold.

We also thank the staff of the Clinical Research Education, Networking

and Consultancy (CRENC), Cameroon for their assistance in data analysis

and interpretation, and for drafting the manuscript. We acknowledge funding

support from Sanofi Aventis pharmaceuticals.

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