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Liu B, Gu S, Zhang J, Zhou H, Su J, Wang S, Sun Q, Zhou Z, Zhou J, Dong C. Green tea consumption and incidence of cardiovascular disease in type 2 diabetic patients with overweight/obesity: a community-based cohort study. Arch Public Health 2024; 82:18. [PMID: 38308353 PMCID: PMC10835928 DOI: 10.1186/s13690-024-01242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Green tea has been reported to be potentially protective against the development of cardiovascular disease (CVD). This study aimed to investigate the association between green tea consumption and incident CVD in type 2 diabetes (T2D) patients with overweight/obesity. METHODS A total of 4756 Chinese overweight/obese T2D patients were recruited and followed up for 6.27 years. Information on green tea consumption was collected at baseline using interviewer-administered questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD according to green tea consumption were estimated using the Cox proportional hazards model. RESULTS Compared with non-habitual consumers, participants who consumed > 5 g/day of green tea leaves reduced the risk of CVD by 29% (95%CI: 0.55-0.92), stroke by 30% (95%CI: 0.51-0.95) and coronary heart disease (CHD) by 40% (95%CI: 0.40-0.89). Similarly, participants who consumed green tea for ≥ 40 years reduced the risk of CVD by 31% (95%CI: 0.54-0.88), stroke by 33% (95%CI: 0.50-0.90) and CHD by 39% (95%CI: 0.42-0.88). Among participants with < 5-year history of T2D, > 5 g/day of tea leaves and > 40 years of tea consumption were associated with 59% (95%CI: 0.23-0.72) and 57% (95%CI: 0.26-0.74) reduced risk of stroke, respectively. However, among participants with ≥ 5-year history of T2D, > 5 g/day of tea leaves and > 40 years of tea consumption were associated with a 50% (95%CI: 0.30-0.82) and 46% (95%CI: 0.35-0.85) reduced risk of CHD, respectively. CONCLUSIONS Green tea consumption is associated with reduced risk of CVD, stroke, and CHD in overweight/obese T2D patients.
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Affiliation(s)
- Bingyue Liu
- Department of Epidemiology and Statistics, School of Public Health, Medical College of Soochow University, Soochow, Jiangsu, China
| | - Shujun Gu
- Suzhou Changshu Centers for Disease Control and Prevention, Soochow, China
| | - Jin Zhang
- Suzhou Industrial Park Centers for Disease Control and Prevention, Soochow, China
| | - Hui Zhou
- Suzhou Industrial Park Centers for Disease Control and Prevention, Soochow, China
| | - Jian Su
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, China
| | - Sudan Wang
- Department of Epidemiology and Statistics, School of Public Health, Medical College of Soochow University, Soochow, Jiangsu, China
| | - Qian Sun
- Department of Epidemiology and Statistics, School of Public Health, Medical College of Soochow University, Soochow, Jiangsu, China
| | - Zhengyuan Zhou
- Suzhou Changshu Centers for Disease Control and Prevention, Soochow, China
| | - Jinyi Zhou
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, China.
| | - Chen Dong
- Department of Epidemiology and Statistics, School of Public Health, Medical College of Soochow University, Soochow, Jiangsu, China.
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Bowo-Ngandji A, Kenmoe S, Ebogo-Belobo JT, Kenfack-Momo R, Takuissu GR, Kengne-Ndé C, Mbaga DS, Tchatchouang S, Kenfack-Zanguim J, Lontuo Fogang R, Zeuko'o Menkem E, Ndzie Ondigui JL, Kame-Ngasse GI, Magoudjou-Pekam JN, Wandji Nguedjo M, Assam Assam JP, Enyegue Mandob D, Ngondi JL. Prevalence of the metabolic syndrome in African populations: A systematic review and meta-analysis. PLoS One 2023; 18:e0289155. [PMID: 37498832 PMCID: PMC10374159 DOI: 10.1371/journal.pone.0289155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations. METHODS A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study. RESULTS In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6). CONCLUSION This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.
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Affiliation(s)
- Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon
| | - Guy Roussel Takuissu
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | | | | | | | | | | | - Ginette Irma Kame-Ngasse
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | | | - Maxwell Wandji Nguedjo
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
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Ochola S, Kanerva N, Wachira LJ, Owino GE, Anono EL, Walsh HM, Okoth V, Erkkola M, Swindell N, Stratton G, Onywera V, Fogelholm M. Wealth and obesity in pre-adolescents and their guardians: A first step in explaining non-communicable disease-related behaviour in two areas of Nairobi City County. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000331. [PMID: 36962946 PMCID: PMC10021148 DOI: 10.1371/journal.pgph.0000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
The prevalence of non-communicable diseases is increasing in lower-middle-income countries as these countries transition to unhealthy lifestyles. The transition is mostly predominant in urban areas. We assessed the association between wealth and obesity in two sub-counties in Nairobi City County, Kenya, in the context of family and poverty. This cross-sectional study was conducted among of 9-14 years old pre-adolescents and their guardians living in low- (Embakasi) and middle-income (Langata) sub-counties. The sociodemographic characteristics were collected using a validated questionnaire. Weight, height, mid-upper arm circumference, and waist circumference were measured using standard approved protocols. Socioeconomic characteristics of the residential sites were accessed using Wealth Index, created by using Principal Component Analysis. Statistical analyses were done by analysis of variance (continuous variables, comparison of areas) and with logistic and linear regression models.A total of 149 households, response rate of 93%, participated, 72 from Embakasi and 77 from Langata. Most of the participants residing in Embakasi belonged to the lower income and education groups whereas participants residing in Langata belonged to the higher income and education groups. About 30% of the pre-adolescent participants in Langata were overweight, compared to 6% in Embakasi (p<0.001). In contrast, the prevalence of adults (mostly mothers) with overweight and obesity was high (65%) in both study areas. Wealth (β = 0.01; SE 0.0; p = 0.003) and income (β = 0.29; SE 0.11; p = 0.009) predicted higher BMI z-score in pre-adolescents. In, pre-adolescent overweight was already highly prevalent in the middle-income area, while the proportion of women with overweight/obesity was high in the low-income area. These results suggest that a lifestyle promoting obesity is high regardless of socioeconomic status and wealth in Kenya. This provides a strong justification for promoting healthy lifestyles across all socio-economic classes.
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Affiliation(s)
- Sophie Ochola
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Noora Kanerva
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Lucy Joy Wachira
- Department of Physical Education, Exercise and Sport Science, Kenyatta University, Nairobi, Kenya
| | - George E. Owino
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya
| | - Esther L. Anono
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Hanna M. Walsh
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Victor Okoth
- Department of Environmental Science, Kenyatta University, Nairobi, Kenya
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Nils Swindell
- Faculty of Science and Engineering, Applied Sport Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
| | - Gareth Stratton
- Faculty of Science and Engineering, Applied Sport Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, United Kingdom
| | - Vincent Onywera
- Department of Physical Education, Exercise and Sport Science, Kenyatta University, Nairobi, Kenya
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
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Bosu WK, Bosu DK. Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis. PLoS One 2021; 16:e0248137. [PMID: 33667277 PMCID: PMC7935309 DOI: 10.1371/journal.pone.0248137] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertension is a major health problem in Ghana, being a leading cause of admissions and deaths in the country. In the context of a changing food and health policy environment, we undertook a systematic review (PROSPERO registration number: CRD42020177174) and a meta-analysis of the prevalence of adult hypertension, and its awareness and control in Ghana. METHODS We searched major databases including PubMed, Embase as well as Google Scholar and online digital collections of public universities of Ghana to locate relevant published and unpublished community-based articles up till April 2020. FINDINGS Eighty-five articles involving 82,045 apparently-healthy subjects aged 15-100 years were analyzed. In individual studies, the prevalence of hypertension, defined in most cases as blood pressure ≥ 140/90 mmHg, ranged from 2.8% to 67.5%. The pooled prevalence from the meta-analysis was 27.0% (95% CI 24.0%-30.0%), being twice as high in the coastal (28%, 95% CI: 24.0%-31.0%) and middle geo-ecological belts (29%, 95% CI: 25.0%-33.0%) as in the northern belt (13%, 95% CI: 7.0%-21.0%). The prevalence was similar by sex, urban-rural residence or peer-review status of the included studies. It did not appear to vary over the study year period 1976-2019. Of the subjects with hypertension, only 35% (95% CI: 29.0%-41.0%) were aware of it, 22% (95% CI: 16.0%-29.0%) were on treatment and 6.0% (95% CI: 3.0%-10.0%) had their blood pressure controlled. Sensitivity analyses corroborated the robust estimates. There was, however, high heterogeneity (I2 = 98.7%) across the studies which was partly explained by prevalent obesity in the subjects. CONCLUSION More than one in four adults in Ghana have hypertension. This high prevalence has persisted for decades and is similar in rural and urban populations. With the low awareness and poor control of hypertension, greater investments in cardiovascular health are required if Ghana is to meet the global target for hypertension.
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Affiliation(s)
- William Kofi Bosu
- Department of Public Health and Research, West African Health Organisation, Bobo-Dioulasso, Burkina Faso
| | - Dary Kojo Bosu
- Department of Paediatrics, St Dominic’s Hospital, Akwatia, Ghana
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Karachaliou F, Simatos G, Simatou A. The Challenges in the Development of Diabetes Prevention and Care Models in Low-Income Settings. Front Endocrinol (Lausanne) 2020; 11:518. [PMID: 32903709 PMCID: PMC7438784 DOI: 10.3389/fendo.2020.00518] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/26/2020] [Indexed: 12/15/2022] Open
Abstract
In low- and middle-income countries (LMICs), the burden of non-communicable diseases such as diabetes is rapidly rising, overpassing the existing burden of communicable diseases. Patients with diabetes living in low-income communities face unique challenges related to lack of awareness, difficulty in accessing health care systems and medications, and consequently failure in achieving optimal diabetes management and preventing complications. Effective diabetes prevention and care models could help reduce the rising burden by standardizing guidelines for prevention and management, improving access to care, engaging community and peers, improving the training of professionals and patients and using the newest technology in the management of the disease. In this article, we review the latest research and evidence on effective models of diabetes prevention and diabetes care delivery in low- income settings. We also provide existing evidence relating to the effectiveness of these models in low-resource contexts, with the aim to highlight characteristics and strengths that make their implementation successful and long-lasting.
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Affiliation(s)
- Feneli Karachaliou
- Unit of Endocrinology, Diabetes and Metabolism, 3rd University Pediatric Department, Attikon University Hospital, Athens, Greece
| | - George Simatos
- Department of Breast Surgery, Agios Savvas Hospital, Athens, Greece
| | - Aristofania Simatou
- Unit of Endocrinology, Diabetes and Metabolism, 3rd University Pediatric Department, Attikon University Hospital, Athens, Greece
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Taddei C, Zhou B, Bixby H, Carrillo-Larco RM, Danaei G, Jackson RT, Farzadfar F, Sophiea MK, Di Cesare M, Iurilli MLC, Martinez AR, Asghari G, Dhana K, Gulayin P, Kakarmath S, Santero M, Voortman T, Riley LM, Cowan MJ, Savin S, Bennett JE, Stevens GA, Paciorek CJ, Aekplakorn W, Cifkova R, Giampaoli S, Kengne AP, Khang YH, Kuulasmaa K, Laxmaiah A, Margozzini P, Mathur P, Nordestgaard BG, Zhao D, Aadahl M, Abarca-Gómez L, Rahim HA, Abu-Rmeileh NM, Acosta-Cazares B, Adams RJ, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahluwalia TS, Ahmad NA, Ahmadi A, Ahmadi N, Ahmed SH, Ahrens W, Ajlouni K, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Aly E, Amarapurkar DN, Amouyel P, Andersen LB, Anderssen SA, Anjana RM, Ansari-Moghaddam A, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assunção MCF, Auvinen J, Avdicová M, Azevedo A, Azizi F, Azmin M, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Barkat A, Bata I, Batieha AM, Batyrbek A, Baur LA, Beaglehole R, Belavendra A, Ben Romdhane H, Benet M, Benn M, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bhargava SK, Bi Y, Bienek A, Bikbov M, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Boehm BO, Boggia JG, Boissonnet CP, Bonaccio M, Bongard V, Borchini R, Borghs H, Bovet P, Brajkovich I, Breckenkamp J, Brenner H, Brewster LM, Bruno G, Bugge A, Busch MA, de León AC, Cacciottolo J, Can G, Cândido APC, Capanzana MV, Capuano E, Capuano V, Cardoso VC, Carvalho J, Casanueva FF, Censi L, Chadjigeorgiou CA, Chamukuttan S, Chaturvedi N, Chen CJ, Chen F, Chen S, Cheng CY, Cheraghian B, Chetrit A, Chiou ST, Chirlaque MD, Cho B, Cho Y, Chudek J, Claessens F, Clarke J, Clays E, Concin H, Confortin SC, Cooper C, Costanzo S, Cottel D, Cowell C, Crujeiras AB, Csilla S, Cui L, Cureau FV, D’Arrigo G, d’Orsi E, Dallongeville J, Damasceno A, Dankner R, Dantoft TM, Dauchet L, Davletov K, De Backer G, De Bacquer D, de Gaetano G, De Henauw S, de Oliveira PD, De Ridder D, De Smedt D, Deepa M, Deev AD, Dehghan A, Delisle H, Dennison E, Deschamps V, Dhimal M, Di Castelnuovo AF, Dika Z, Djalalinia S, Dobson AJ, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Dragano N, Drygas W, Du Y, Duante CA, Duda RB, Dzerve V, Dziankowska-Zaborszczyk E, Eddie R, Eftekhar E, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El Ati J, Eldemire-Shearer D, Eliasen M, Elosua R, Erasmus RT, Erbel R, Erem C, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fall CH, Faramarzi E, Farjam M, Fattahi MR, Felix-Redondo FJ, Ferguson TS, Fernández-Bergés D, Ferrante D, Ferrari M, Ferreccio C, Ferrieres J, Föger B, Foo LH, Forslund AS, Forsner M, Fouad HM, Francis DK, do Carmo Franco M, Franco OH, Frontera G, Fujita Y, Fumihiko M, Furusawa T, Gaciong Z, Galvano F, Gao J, Garcia-de-la-Hera M, Garnett SP, Gaspoz JM, Gasull M, Gazzinelli A, Geleijnse JM, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gianfagna F, Gill TK, Giovannelli J, Gironella G, Giwercman A, Goltzman D, Gonçalves H, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graff-Iversen S, Grafnetter D, Gregor RD, Grodzicki T, Grøntved A, Grosso G, Gruden G, Gu D, Guallar-Castillón P, Guan OP, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Gunnlaugsdottir J, Gupta R, Gutierrez L, Gutzwiller F, Ha S, Hadaegh F, Haghshenas R, Hakimi H, Hambleton IR, Hamzeh B, Hantunen S, Kumar RH, Hashemi-Shahri SM, Hata J, Haugsgjerd T, Hayes AJ, He J, He Y, Hendriks ME, Henriques A, Herrala S, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Hofman A, Homayounfar R, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Huerta JM, Huhtaniemi IT, Huisman M, Hunsberger ML, Husseini AS, Huybrechts I, Hwalla N, Iacoviello L, Iannone AG, Ibrahim MM, Wong NI, Iglesia I, Ikeda N, Ikram MA, Iotova V, Irazola VE, Ishida T, Islam M, al-Safi Ismail A, Iwasaki M, Jacobs JM, Jaddou HY, Jafar T, James K, Jamrozik K, Janszky I, Janus E, Jarvelin MR, Jasienska G, Jelakovic A, Jelakovic B, Jennings G, Jensen GB, Jeong SL, Jha AK, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Jokelainen JJ, Jonas JB, Jørgensen T, Joshi P, Joukar F, Józwiak J, Juolevi A, Kafatos A, Kajantie EO, Kalter-Leibovici O, Kamaruddin NA, Kamstrup PR, Karki KB, Katz J, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva G, Keil U, Keinänen-Kiukaanniemi S, Kelishadi R, Keramati M, Kerimkulova A, Kersting M, Khader YS, Khalili D, Khateeb M, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl S, Killewo J, Kim HC, Kim J, Kim YY, Klumbiene J, Knoflach M, Ko S, Kohler HP, Kohler IV, Kolle E, Kolsteren P, König J, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kouda K, Kowlessur S, Kratzer W, Kriemler S, Kristensen PL, Krokstad S, Kromhout D, Kujala UM, Kurjata P, Kyobutungi C, Laamiri FZ, Laatikainen T, Lachat C, Laid Y, Lam TH, Lambrinou CP, Lanska V, Lappas G, Larijani B, Latt TS, Laugsand LE, Lazo-Porras M, Lee J, Lee J, Lehmann N, Lehtimäki T, Levitt NS, Li Y, Lilly CL, Lim WY, Lima-Costa MF, Lin HH, Lin X, Lin YT, Lind L, Linneberg A, Lissner L, Liu J, Loit HM, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Luksiene D, Lundqvist A, Lundqvist R, Lunet N, Ma G, Machado-Coelho GLL, Machado-Rodrigues AM, Machi S, Madar AA, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Makdisse M, Malekzadeh F, Malekzadeh R, Rao KM, Manios Y, Mann JI, Mansour-Ghanaei F, Manzato E, Marques-Vidal P, Martorell R, Mascarenhas LP, Mathiesen EB, Matsha TE, Mavrogianni C, McFarlane SR, McGarvey ST, McLachlan S, McLean RM, McLean SB, McNulty BA, Mediene-Benchekor S, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisinger C, Menezes AMB, Menon GR, Merat S, Mereke A, Meshram II, Metcalf P, Meyer HE, Mi J, Michels N, Miller JC, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Mirrakhimov E, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohammad K, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Yusoff MFM, Mohebbi I, Mohebi F, Moitry M, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monterrubio-Flores E, Moosazadeh M, Morejon A, Moreno LA, Morgan K, Morin SN, Moschonis G, Mossakowska M, Mostafa A, Mota J, Motlagh ME, Motta J, Msyamboza KP, Muiesan ML, Müller-Nurasyid M, Mursu J, Mustafa N, Nabipour I, Naderimagham S, Nagel G, Naidu BM, Najafi F, Nakamura H, Námešná J, Nang EEK, Nangia VB, Nauck M, Neal WA, Nejatizadeh A, Nenko I, Nervi F, Nguyen ND, Nguyen QN, Nieto-Martínez RE, Nihal T, Niiranen TJ, Ning G, Ninomiya T, Noale M, Noboa OA, Noto D, Nsour MA, Nuhoğlu I, O’Neill TW, O’Reilly D, Ochoa-Avilés AM, Oh K, Ohtsuka R, Olafsson Ö, Olié V, Oliveira IO, Omar MA, Onat A, Ong SK, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostojic SM, Ostovar A, Otero JA, Owusu-Dabo E, Paccaud FM, Pahomova E, Pajak A, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Parnell WR, Patel ND, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peters A, Petersmann A, Petkeviciene J, Peykari N, Pham ST, Pichardo RN, Pigeot I, Pilav A, Pilotto L, Piwonska A, Pizarro AN, Plans-Rubió P, Plata S, Pohlabeln H, Porta M, Portegies MLP, Poudyal A, Pourfarzi F, Poustchi H, Pradeepa R, Price JF, Providencia R, Puder JJ, Puhakka SE, Punab M, Qorbani M, Bao TQ, Radisauskas R, Rahimikazerooni S, Raitakari O, Rao SR, Ramachandran A, Ramos E, Ramos R, Rampal L, Rampal S, Redon J, Reganit PFM, Revilla L, Rezaianzadeh A, Ribeiro R, Richter A, Rigo F, Rinke de Wit TF, Rodríguez-Artalejo F, del Cristo Rodriguez-Perez M, Rodríguez-Villamizar LA, Roggenbuck U, Rojas-Martinez R, Romaguera D, Romeo EL, Rosengren A, Roy JGR, Rubinstein A, Ruidavets JB, Ruiz-Betancourt BS, Russo P, Rust P, Rutkowski M, Sabanayagam C, Sachdev HS, Sadjadi A, Safarpour AR, Safiri S, Saidi O, Saki N, Salanave B, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Sánchez-Abanto J, Sans S, Santaliestra-Pasías AM, Santos DA, Santos MP, Santos R, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Savva SC, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schargrodsky H, Scheidt-Nave C, Schienkiewitz A, Schipf S, Schmidt CO, Schöttker B, Schramm S, Sebert S, Sein AA, Sen A, Sepanlou SG, Servais J, Shakeri R, Shalnova SA, Shamah-Levy T, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shi Z, Shibuya K, Shimizu-Furusawa H, Shin DW, Shin Y, Shirani M, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Skaaby T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Snijder MB, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Sørensen TIA, Jérome CS, Soumaré A, Sozmen K, Sparrenberger K, Staessen JA, Stathopoulou MG, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stronks K, Strufaldi MW, Suárez-Medina R, Sun CA, Sundström J, Suriyawongpaisal P, Sy RG, Sylva RC, Szklo M, Tai ES, Tamosiunas A, Tan EJ, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tell GS, Tello T, Thankappan KR, Thijs L, Thuesen BH, Toft U, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Traissac P, Trinh OTH, Truthmann J, Tsugane S, Tulloch-Reid MK, Tuomainen TP, Tuomilehto J, Tybjaerg-Hansen A, Tzourio C, Ueda P, Ugel E, Ulmer H, Unal B, Uusitalo HMT, Valdivia G, Valvi D, van Dam RM, van der Schouw YT, Van Herck K, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varona-Pérez P, Vasan SK, Vatten L, Vega T, Veidebaum T, Velasquez-Melendez G, Venero-Fernández SJ, Veronesi G, Verschuren WMM, Victora CG, Vidiawati D, Viet L, Villalpando S, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vlasoff T, Vollenweider P, Voutilainen A, Wade AN, Wagner A, Walton J, Bebakar WMW, Mohamud WNW, Wang MD, Wang N, Wang Q, Wang YX, Wang YW, Wannamethee SG, Wedderkopp N, Wei W, Whincup PH, Widhalm K, Widyahening IS, Wiecek A, Wijga AH, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong A, Wong TY, Woo J, Woodward M, Wu FC, Wu S, Xu H, Xu L, Yan W, Yang X, Yasuharu T, Ye X, Yeow TP, Yiallouros PK, Yoosefi M, Yoshihara A, You SL, Younger-Coleman NO, Yusoff AF, Zainuddin AA, Zakavi SR, Zali MR, Zamani F, Zambon S, Zampelas A, Zaw KK, Zdrojewski T, Vrkic TZ, Zhang ZY, Zhao W, Zhen S, Zheng Y, Zholdin B, Zhussupov B, Zoghlami N, Cisneros JZ, Gregg EW, Ezzati M. Repositioning of the global epicentre of non-optimal cholesterol. Nature 2020; 582:73-77. [PMID: 32494083 PMCID: PMC7332422 DOI: 10.1038/s41586-020-2338-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/02/2020] [Indexed: 11/25/2022]
Abstract
High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular risk-changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.
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Bosu WK, Reilly ST, Aheto JMK, Zucchelli E. Hypertension in older adults in Africa: A systematic review and meta-analysis. PLoS One 2019; 14:e0214934. [PMID: 30951534 PMCID: PMC6450645 DOI: 10.1371/journal.pone.0214934] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/23/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hypertension is the leading driver of cardiovascular disease deaths in Africa. Its prevalence is highest in older populations. Yet, this group has received little attention in many African countries. We conducted a systematic review and meta-analysis (PROSPERO registration: CRD42017056474) to estimate the prevalence of hypertension in older adults living in Africa. METHODS We searched grey literature and major electronic databases including PubMed and Embase for population-based studies and published between 1 January 1980 to 28 May 2018 reporting the prevalence of hypertension for adults aged ≥50 years living in Africa. We employed a random effects model to estimate the pooled prevalence across included studies. FINDINGS We screened 10,719 articles and retrieved 103 full-text articles to evaluate for inclusion in the review. Thirty-four unique studies providing 37 data points on 43,025 individuals in 15 African countries were analyzed. The prevalence of hypertension ranged from 22.3% to 90.0% from the individual studies while the overall pooled prevalence was 57.0% (95% CI 52%-61%). The prevalence was not statistically significantly different by sex, residence, or African sub-region. In individual studies, older age and overweight/obesity were independently associated with hypertension. Twenty-nine (78%) data points were deemed to be of low- or moderate-risk of bias. Eliminating high-risk bias studies made little difference to the pooled estimate of hypertension. Sensitivity analyses, omitting one study at a time, identified three studies with significant but relatively small impact on the pooled estimate. We observed substantial heterogeneity (I2 = 98.9%) across the studies which was further explored by meta-regression analyses. Overall, the GRADE assessment suggested moderate quality evidence in the results. CONCLUSION The persistent high prevalence of hypertension among older adults in Africa, even in rural populations warrants more attention to the cardiovascular health of this group by public health authorities.
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Affiliation(s)
- William Kofi Bosu
- Department of Public Health and Research, West African Health Organisation, Bobo-Dioulasso, Burkina Faso
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, United Kingdom
| | - Siobhan Theresa Reilly
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, United Kingdom
| | | | - Eugenio Zucchelli
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, United Kingdom
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Manne-Goehler J, Geldsetzer P, Agoudavi K, Andall-Brereton G, Aryal KK, Bicaba BW, Bovet P, Brian G, Dorobantu M, Gathecha G, Singh Gurung M, Guwatudde D, Msaidie M, Houehanou C, Houinato D, Jorgensen JMA, Kagaruki GB, Karki KB, Labadarios D, Martins JS, Mayige MT, McClure RW, Mwalim O, Mwangi JK, Norov B, Quesnel-Crooks S, Silver BK, Sturua L, Tsabedze L, Wesseh CS, Stokes A, Marcus M, Ebert C, Davies JI, Vollmer S, Atun R, Bärnighausen TW, Jaacks LM. Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys. PLoS Med 2019; 16:e1002751. [PMID: 30822339 PMCID: PMC6396901 DOI: 10.1371/journal.pmed.1002751] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/23/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. METHODS AND FINDINGS We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%-9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%-5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%-78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. CONCLUSIONS The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.
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Affiliation(s)
- Jennifer Manne-Goehler
- Divison of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Glennis Andall-Brereton
- Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | | | - Brice Wilfried Bicaba
- Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ouagadougou, Burkina Faso
| | - Pascal Bovet
- Ministry of Health, Victoria, Seychelles
- Institute of Social and Preventive Medicine, Lausanne, Switzerland
| | - Garry Brian
- The Fred Hollows Foundation NZ, Auckland, New Zealand
| | - Maria Dorobantu
- Cardiology Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Gladwell Gathecha
- Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Mohamed Msaidie
- Comoros Ministry of Health, Solidarity, Social Cohesion and Gender, Moroni, Comoros
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | | | | | | | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Joao S. Martins
- Faculty of Medicine and Health Sciences, National University of East Timor, Dili, Timor-Leste
| | - Mary T. Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Roy Wong McClure
- Office of Epidemiology and Surveillance, Caja Costarricense de Seguro Social, San Jose, Costa Rica
| | - Omar Mwalim
- Zanzibar Ministry of Health, Mnazi Mmoja, Zanzibar
| | | | - Bolormaa Norov
- National Center for Public Health, Ulaanbaatar, Mongolia
| | - Sarah Quesnel-Crooks
- Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | | | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | - Andrew Stokes
- Boston University Center for Global Health and Development, Boston, Massachusetts, United States of America
| | - Maja Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Cara Ebert
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Justine I. Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute for Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Sebastian Vollmer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Till W. Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Africa Health Research Institute, Somkhele, South Africa
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Public Health Foundation of India, New Delhi, India
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Chamik T, Viswanathan B, Gedeon J, Bovet P. Associations between psychological stress and smoking, drinking, obesity, and high blood pressure in an upper middle-income country in the African region. Stress Health 2018; 34:93-101. [PMID: 28586134 DOI: 10.1002/smi.2766] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/17/2017] [Accepted: 05/14/2017] [Indexed: 11/06/2022]
Abstract
The direction and magnitude of the associations between cardiovascular risk factors (CVRFs) and psychological stress continue to be debated, and no data are available from surveys in the African region. In this study, we examine the associations between CVRFs and psychological stress in the Seychelles, a rapidly developing small island state in the African region. A survey was conducted in 1,240 adults aged 25-64 years representative of the Seychelles. Participants were asked to rank psychological stress that they had experienced during the past 12 months in four domains: work, social life, financial situation, and environment around home. CVRFs (high blood pressure, tobacco use, alcohol drinking, and obesity) were assessed using standard procedures. Psychological stress was associated with age, sex, and socioeconomic status. Overall, there were only few consistent associations between psychological stress and CVRFs, adjusting for age, sex, and socioeconomic status. Social stress was associated with smoking, drinking, and obesity, and there were marginal associations between stress at work and drinking, and between financial stress, and smoking and drinking. Psychological stress was not associated with high blood pressure. These findings suggest that psychological stress should be considered in cardiovascular disease prevention and control strategies.
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Affiliation(s)
- Tanja Chamik
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Jude Gedeon
- Ministry of Health, Victoria, Republic of Seychelles
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
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Cham B, Scholes S, Ng Fat L, Badjie O, Mindell JS. Burden of hypertension in The Gambia: evidence from a national World Health Organization (WHO) STEP survey. Int J Epidemiol 2018; 47:860-871. [PMID: 29394353 DOI: 10.1093/ije/dyx279] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/04/2017] [Accepted: 01/15/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-communicable diseases are increasing in sub-Saharan Africa and are estimated to account for 32% of adult deaths in The Gambia. Worldwide, prevalence of hypertension is highest in the African region (46%) and a very high proportion is undiagnosed. This study examined diagnosed and undiagnosed hypertension in The Gambian adult population. METHODS Data were collected in 2010 from a nationally representative random sample of 4111 adults aged 25-64 years, using the World Health Organization STEPwise cross-sectional survey methods. Analyses were restricted to non-pregnant participants with three valid blood pressure measurements (n = 3573). We conducted gender-stratified univariate and multivariate regression analyses to identify the strongest sociodemographic, behavioural and biological risk factors associated with hypertension. RESULTS Almost one-third of adults were hypertensive; a high proportion were undiagnosed, particularly among men (86% of men vs 71% of women with hypertension, P < 0.001). Rural and semi-urban residents and overweight/obese persons had increased odds of hypertension. Compared with urban residents, participants from one of the most rural regions had higher odds of hypertension among both men [adjusted odds ratio (AOR) 3.2; 95% CI: 1.6-6.4] and women (AOR 2.5; 95% CI: 1.3-4.6). Other factors strongly associated with hypertension in multivariate analyses were age, smoking, physical inactivity and ethnicity. CONCLUSIONS Rural and semi-urban residence were strongly associated with hypertension, contrary to what has been found in similar studies in sub-Saharan Africa. Intervention to reduce the burden of hypertension in The Gambia could be further targeted towards rural areas.
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Affiliation(s)
- Bai Cham
- University College London, Department of Epidemiology and Public Health, London, UK.,University of The Gambia, Department of Public Health, Brikama Campus, P.O. Box 3530, Serrekunda, The Gambia and
| | - Shaun Scholes
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Linda Ng Fat
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Omar Badjie
- Non-Communicable Diseases Unit, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Jennifer S Mindell
- University College London, Department of Epidemiology and Public Health, London, UK
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Trends in prevalence, awareness, treatment and control of high blood pressure in the Seychelles between 1989 and 2013. J Hypertens 2017; 35:1465-1473. [DOI: 10.1097/hjh.0000000000001358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kakarmath SS, Zack RM, Leyna GH, Fahimi S, Liu E, Fawzi WW, Lukmanji Z, Killewo J, Sacks F, Danaei G. Dietary determinants of serum total cholesterol among middle-aged and older adults: a population-based cross-sectional study in Dar es Salaam, Tanzania. BMJ Open 2017; 7:e015028. [PMID: 28588111 PMCID: PMC5663012 DOI: 10.1136/bmjopen-2016-015028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the dietary determinants of serum total cholesterol. DESIGN Cross-sectional population-based study. SETTING Peri-urban region of Dar es Salaam, Tanzania. PARTICIPANTS 347 adults aged 40 years and older from the Dar es Salaam Urban Cohort Hypertension Study. MAIN OUTCOME MEASURE Serum total cholesterol measured using a point-of-care device. RESULTS Mean serum total cholesterol level was 204 mg/dL (IQR 169-236 mg/dL) in women and 185 mg/dL (IQR 152-216 mg/dL) in men. After adjusting for demographic, socioeconomic, lifestyle and dietary factors, participants who reported using palm oil as the major cooking oil had serum total cholesterol higher by 15 mg/dL (95% CI 1 to 29 mg/dL) compared with those who reported using sunflower oil. Consumption of one or more servings of meat per day (p for trend=0.017) and less than five servings of fruits and vegetables per day (p for trend=0.024) were also associated with higher serum total cholesterol. A combination of using palm oil for cooking, eating more than one serving of meat per day and fewer than five servings of fruits and vegetables per day, was associated with 46 mg/dL (95% CI 16 to 76 mg/dL) higher serum total cholesterol. CONCLUSIONS Using palm oil for cooking was associated with higher serum total cholesterol levels in this peri-urban population in Dar es Salaam. Reduction of saturated fat content of edible oil may be considered as a population-based strategy for primary prevention of cardiovascular diseases.
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Affiliation(s)
- Sujay S Kakarmath
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel M Zack
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Germana H Leyna
- Department of Epidemiology and Biostatistics, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Saman Fahimi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Enju Liu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Zohra Lukmanji
- World food program, Dar es Salaam and Tumaini Hospital, Dar es Salaam, Tanzania
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Frank Sacks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Mayén AL, Bovet P, Marti-Soler H, Viswanathan B, Gedeon J, Paccaud F, Marques-Vidal P, Stringhini S. Socioeconomic Differences in Dietary Patterns in an East African Country: Evidence from the Republic of Seychelles. PLoS One 2016; 11:e0155617. [PMID: 27214139 PMCID: PMC4877066 DOI: 10.1371/journal.pone.0155617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 05/02/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In high income countries, low socioeconomic status (SES) is related to unhealthier dietary patterns, while evidence on the social patterning of diet in low and middle income countries is scarce. OBJECTIVE In this study, we assess dietary patterns in the general population of a middle income country in the African region, the Republic of Seychelles, and examine their distribution according to educational level and income. METHODS Data was drawn from two independent national surveys conducted in the Seychelles among adults aged 25-64 years in 2004 (n = 1236) and 2013 (n = 1240). Dietary patterns were assessed by principal component analysis (PCA). Educational level and income were used as SES indicators. Data from both surveys were combined as no interaction was found between SES and year. RESULTS Three dietary patterns were identified: "snacks and drinks", "fruit and vegetables" and "fish and rice". No significant associations were found between SES and the "snacks and drinks" pattern. Low vs. high SES individuals had lower adherence to the "fruit and vegetables" pattern [prevalence ratio (95% CI) 0.71 (0.60-0.83)] but a higher adherence to the traditional "fish and rice" pattern [1.58 (1.32-1.88)]. Income modified the association between education and the "fish and rice" pattern (p = 0.02), whereby low income individuals had a higher adherence to this pattern in both educational groups. CONCLUSION Low SES individuals have a lower consumption of fruit and vegetables, but a higher consumption of traditional foods like fish and rice. The Seychelles may be at a degenerative diseases stage of the nutrition transition.
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Affiliation(s)
- Ana-Lucia Mayén
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- * E-mail:
| | - Helena Marti-Soler
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | | | - Jude Gedeon
- Ministry of Health, Victoria, Republic of Seychelles
| | - Fred Paccaud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
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Cournot M, Lenclume V, Le Moullec N, Debussche X, Doussiet E, Fagot-Campagna A, Favier F. Prevalence, treatment and control of hypertension in La Réunion: the RÉDIA population-based cohort study. Blood Press 2016; 26:39-47. [PMID: 27195533 DOI: 10.1080/08037051.2016.1182854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A better knowledge of prevalence, management and determinants of hypertension is needed in regions in epidemiological transition to adapt the strategies of public health screening and prevention, and to reduce the burden of cardiovascular diseases. We conducted a prospective cohort study including 4610 participants aged between 18 and 69 years and representative of the general population of La Réunion, a French overseas island located in the western Indian Ocean. The median time between inclusion and follow-up was 7.4 years. Blood pressure data at baseline and follow-up of 3087 participants were analyzed. We found a high prevalence of hypertension, especially in women (36.7% [34.5-39.0]) and in men (40.3% [37.6-43.0]) and in the under 30s (17.1% [14.0-20.5]), with an increase of 10% at follow-up. Treatment rates were very low in men (19.5% versus 39.1% in women) as was awareness of their condition (25.7% versus 44.6%). Blood pressure control rates were similar (18% at baseline and 34% at follow-up for both sexes). Diagnosis of hypertension at follow-up among subjects normotensive at baseline was independently associated with obesity at baseline (relative risk (RR) = 1.40 [1.12-1.75] for BMI between 27 and 30 kg/m2 and 1.72 [1.33-2.25] for BMI ≥30 kg/m2 as compared with BMI <27 kg/m2) and HbA1C (RR =1.12 [1.05-1.19] per %), suggesting a prominent role of insulin resistance in our population. Our study provides original data that cannot be assimilated to any existing model and should guide the implementation of original community-based programs in such countries.
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Affiliation(s)
- Maxime Cournot
- a CHU de La Réunion, Centre d'Investigations Cliniques , Saint Denis , France.,b INSERM, CIC 1410 , Saint Pierre , France.,c INSERM, UMR 1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI) , Sainte-Clotilde , France.,d Centre Hospitalier Gabriel Martin, Service de cardiologie , Saint-Paul , France
| | | | - Nathalie Le Moullec
- e CHU de La Réunion, Service d'endocrinologie, diabétologie et nutrition , Saint-Pierre , France
| | - Xavier Debussche
- f CHU de La Réunion, Service d'endocrinologie et diabétologie , Saint-Denis , France
| | | | - Anne Fagot-Campagna
- g Direction de la Stratégie, des Etudes et des Statistiques, Caisse Nationale d'Assurance Maladie des Travailleurs Salariés , Paris , France
| | - François Favier
- b INSERM, CIC 1410 , Saint Pierre , France.,e CHU de La Réunion, Service d'endocrinologie, diabétologie et nutrition , Saint-Pierre , France
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Stauffer F, Viswanathan B, Jean M, Kinabo P, Bovet P. Comparison between capillary glucose measured with a Contour glucometer and plasma glucose in a population survey. ACTA ACUST UNITED AC 2016. [DOI: 10.1515/labmed-2015-0089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractCapillary glucose (CG) measured with point-of-care glucometers can provide useful approximation of plasma glucose (PG) in selected circumstances but the validity of measurements has been adequately assessed only for a few glucometers.We assessed the difference between CG measured with a glucometer (Contour Ascensia, Bayer) and PG measured with a standard laboratory method in participants to a population-based cardiovascular survey in the Seychelles (sample size 1227).CG correlated well with PG (r=0.94; p<0.001). The overall difference between PG and CG was –0.55 mmol/L for PG <4.0 mmol/L (n=19; 95% CI –0.92; –0.18); 0.14 mmol/L for PG 4.0–4.9 (n=344; 95% CI 0.08–0.20) and increased according to PG up to 1.64 mmol/L for PG >9.0 mmol/L (n=68; 95% CI 1.36; 1.91). The prevalence of diabetes in the study sample was 29% lower with CG than with PG (8.6% vs. 12.1%) but this bias could be corrected by analytical re-calibration.CG underestimated PG, although the bias was small among persons with low glycemia. This systematic difference may bear little significance when the purpose is to simply monitor blood glucose but has large impact on prevalence estimates at the population level if CG values are not adequately calibrated.
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16
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Zhao P, Wang JG, Gao P, Li X, Brewer R. Sudden unexpected death from natural diseases: Fifteen years' experience with 484 cases in Seychelles. J Forensic Leg Med 2015; 37:33-8. [PMID: 26580722 DOI: 10.1016/j.jflm.2015.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 09/08/2015] [Accepted: 10/24/2015] [Indexed: 11/24/2022]
Abstract
The aim of this study is to identify and subclassify sudden natural death (sudden death from natural diseases) cases in Seychelles. A total of 484 sudden natural death cases with autopsy at the Clinical Pathology Laboratory, Victoria Hospital, Seychelles between 1997 through 2012 were retrospectively reviewed. Among them, 363 cases (75%) were male and 121 (25%) were female. The most frequent sudden deaths were attributed to cardiovascular diseases (78.5%), and then followed by infectious diseases (9.9%), and gastrointestinal diseases (9.1%). This is the largest population-based study on sudden natural deaths in Seychelles.
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Affiliation(s)
- Peng Zhao
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Ji-Gang Wang
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
| | - Peng Gao
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Xia Li
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Rubell Brewer
- Clinical Pathology Laboratory, Victoria Hospital, Ministry of Health, P.O.BOX 52, MAHE, Seychelles
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Atiase Y, Farni K, Plange-Rhule J, Luke A, Bovet P, Forrester TG, Lambert V, Levitt NS, Kliethermes S, Cao G, Durazo-Arvizu RA, Cooper RS, Dugas LR. A comparison of indices of glucose metabolism in five black populations: data from modeling the epidemiologic transition study (METS). BMC Public Health 2015; 15:895. [PMID: 26374293 PMCID: PMC4572672 DOI: 10.1186/s12889-015-2233-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 09/04/2015] [Indexed: 12/25/2022] Open
Abstract
Background Globally, Africans and African Americans experience a disproportionate burden of type 2 diabetes, compared to other race and ethnic groups. The aim of the study was to examine the association of plasma glucose with indices of glucose metabolism in young adults of African origin from 5 different countries. Methods We identified participants from the Modeling the Epidemiologic Transition Study, an international study of weight change and cardiovascular disease (CVD) risk in five populations of African origin: USA (US), Jamaica, Ghana, South Africa, and Seychelles. For the current study, we included 667 participants (34.8 ± 6.3 years), with measures of plasma glucose, insulin, leptin, and adiponectin, as well as moderate and vigorous physical activity (MVPA, minutes/day [min/day]), daily sedentary time (min/day), anthropometrics, and body composition. Results Among the 282 men, body mass index (BMI) ranged from 22.1 to 29.6 kg/m2 in men and from 25.8 to 34.8 kg/m2 in 385 women. MVPA ranged from 26.2 to 47.1 min/day in men, and from 14.3 to 27.3 min/day in women and correlated with adiposity (BMI, waist size, and % body fat) only among US males after controlling for age. Plasma glucose ranged from 4.6 ± 0.8 mmol/L in the South African men to 5.8 mmol/L US men, while the overall prevalence for diabetes was very low, except in the US men and women (6.7 and 12 %, respectively). Using multivariate linear regression, glucose was associated with BMI, age, sex, smoking hypertension, daily sedentary time but not daily MVPA. Conclusion Obesity, metabolic risk, and other potential determinants vary significantly between populations at differing stages of the epidemiologic transition, requiring tailored public health policies to address local population characteristics.
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Affiliation(s)
| | - Kathryn Farni
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | | | - Amy Luke
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Pascal Bovet
- Institute of Social & Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. .,Switzerland & Ministry of Health, Victoria, Republic of Seychelles.
| | - Terrence G Forrester
- Solutions for Developing Countries (SODECO), University of the West Indies, Mona, Kingston, Jamaica.
| | - Vicki Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.
| | - Naomi S Levitt
- Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Stephanie Kliethermes
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Guichan Cao
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Ramon A Durazo-Arvizu
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Richard S Cooper
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Lara R Dugas
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA. .,Public Health Sciences, 2160 S. 1st Ave, Maywood, IL, 60153, USA.
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Ezzati M, Obermeyer Z, Tzoulaki I, Mayosi BM, Elliott P, Leon DA. Contributions of risk factors and medical care to cardiovascular mortality trends. Nat Rev Cardiol 2015; 12:508-30. [PMID: 26076950 PMCID: PMC4945698 DOI: 10.1038/nrcardio.2015.82] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ischaemic heart disease, stroke, and other cardiovascular diseases (CVDs) lead to 17.5 million deaths worldwide per year. Taking into account population ageing, CVD death rates are decreasing steadily both in regions with reliable trend data and globally. The declines in high-income countries and some Latin American countries have been ongoing for decades without slowing. These positive trends have broadly coincided with, and benefited from, declines in smoking and physiological risk factors, such as blood pressure and serum cholesterol levels. These declines have also coincided with, and benefited from, improvements in medical care, including primary prevention, diagnosis, and treatment of acute CVDs, as well as post-hospital care, especially in the past 40 years. These variables, however, explain neither why the decline began when it did, nor the similarities and differences in the start time and rate of the decline between countries and sexes. In Russia and some other former Soviet countries, changes in volume and patterns of alcohol consumption have caused sharp rises in CVD mortality since the early 1990s. An important challenge in reaching firm conclusions about the drivers of these remarkable international trends is the paucity of time-trend data on CVD incidence, risk factors throughout the life-course, and clinical care.
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Affiliation(s)
- Majid Ezzati
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Ziad Obermeyer
- Department of Emergency Medicine, Harvard Medical School, Neville House, 75 Francis Street, Boston, MA 02115, USA
| | - Ioanna Tzoulaki
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Main Building, Observatory, Cape Town 7925, South Africa
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - David A Leon
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Sciences, London School of Hygiene &Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Shukla S, Anand Kumar D, Anusha SV, Tiwari AK. Antihyperglucolipidaemic and anticarbonyl stress properties in green, yellow and red sweet bell peppers (Capsicum annuumL.). Nat Prod Res 2015; 30:583-9. [DOI: 10.1080/14786419.2015.1026343] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Stringhini S, Rousson V, Viswanathan B, Gedeon J, Paccaud F, Bovet P. Association of socioeconomic status with overall and cause specific mortality in the Republic of Seychelles: results from a cohort study in the African region. PLoS One 2014; 9:e102858. [PMID: 25057938 PMCID: PMC4109956 DOI: 10.1371/journal.pone.0102858] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low socioeconomic status (SES) is consistently associated with higher mortality in high income countries. Only few studies have assessed this association in low and middle income countries, mainly because of sparse reliable mortality data. This study explores SES differences in overall and cause-specific mortality in the Seychelles, a rapidly developing small island state in the African region. METHODS All deaths have been medically certified over more than two decades. SES and other lifestyle-related risk factors were assessed in a total of 3246 participants from three independent population-based surveys conducted in 1989, 1994 and 2004. Vital status was ascertained using linkage with vital statistics. Occupational position was the indicator of SES used in this study and was assessed with the same questions in the three surveys. RESULTS During a mean follow-up of 15.0 years (range 0-23 years), 523 participants died (overall mortality rate 10.8 per 1000 person-years). The main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a higher mortality risk for overall (HR = 1.80; 95% CI: 1.24-2.62), CVD (HR = 1.95; 1.04-3.65) and non-cancer/non-CVD (HR = 2.14; 1.10-4.16) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR = 1.44; 0.76-2.75). Major lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained a small proportion of the associations between low SES and all-cause, CVD, and non-cancer/non-CVD mortality. CONCLUSIONS In this population-based study assessing social inequalities in mortality in a country of the African region, low SES (as measured by occupational position) was strongly associated with overall, CVD and non-cancer/non-CVD mortality. Our findings support the view that the burden of non-communicable diseases may disproportionally affect people with low SES in low and middle income countries.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Valentin Rousson
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Jude Gedeon
- Ministry of Health, Victoria, Republic of Seychelles
| | - Fred Paccaud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Ministry of Health, Victoria, Republic of Seychelles
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Yerly P, Madeleine G, Riesen W, Bovet P. Low prevalence of abdominal aortic aneurysm in the Seychelles population aged 50 to 65 years. Cardiovasc J Afr 2013; 24:17-8. [PMID: 23612948 PMCID: PMC3734875 DOI: 10.5830/cvja-2012-070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 10/08/2012] [Indexed: 11/06/2022] Open
Abstract
Abstract The prevalence of abdominal aortic aneurysm (AAA) and its risk factors are well known in Western countries but few data are available from low- and middle-income countries. We are not aware of systematically collected population-based data on AAA in the African region. We evaluated the prevalence of AAA in a population-based cardiovascular survey conducted in the Republic of Seychelles in 2004 (Indian Ocean, African region). Among the 353 participants aged 50 to 64 years and screened with ultrasound, the prevalence of AAA was 0.3% (95% CI: 0–0.9) and the prevalence of ectatic dilatations of the abdominal aorta was 1.5% (95% CI: 0.2–2.8). The prevalence of AAA in the general population seemed lower in Seychelles than in Western countries, despite a high prevalence in Seychelles of risk factors of AAA, such as smoking (in men), high blood pressure and hypercholesterolaemia.
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Affiliation(s)
- Patrick Yerly
- Department of Internal Medicine, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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Cooper RS, Bovet P. Measures of health and disease in Africa: are current methods giving us useful information about trends in cardiovascular diseases? Prog Cardiovasc Dis 2013; 56:270-7. [PMID: 24267434 DOI: 10.1016/j.pcad.2013.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An enormous burst of interest in the public health burden from chronic disease in Africa has emerged as a consequence of efforts to estimate global population health. Detailed estimates are now published for Africa as a whole and each country on the continent. These data have formed the basis for warnings about sharp increases in cardiovascular disease (CVD) in the coming decades. In this essay we briefly examine the trajectory of social development on the continent and its consequences for the epidemiology of CVD and potential control strategies. Since full vital registration has only been implemented in segments of South Africa and the island nations of Seychelles and Mauritius - formally part of WHO-AFRO - mortality data are extremely limited. Numerous sample surveys have been conducted but they often lack standardization or objective measures of health status. Trend data are even less informative. However, using the best quality data available, age-standardized trends in CVD are downward, and in the case of stroke, sharply so. While acknowledging that the extremely limited available data cannot be used as the basis for inference to the continent, we raise the concern that general estimates based on imputation to fill in the missing mortality tables may be even more misleading. No immediate remedies to this problem can be identified, however bilateral collaborative efforts to strength local educational institutions and governmental agencies rank as the highest priority for near term development.
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Affiliation(s)
- Richard S Cooper
- Department of Public Health Sciences, Loyola University Stritch School of Medicine, Maywood, IL.
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Stringhini S, Bovet P. Commentary: The social transition of cardiovascular disease in low- and middle-income countries: wait and see is not an option. Int J Epidemiol 2013; 42:1429-31. [DOI: 10.1093/ije/dyt084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bloomfield GS, Mwangi A, Chege P, Simiyu CJ, Aswa DF, Odhiambo D, Obala AA, Ayuo P, Khwa-Otsyula BO. Multiple cardiovascular risk factors in Kenya: evidence from a health and demographic surveillance system using the WHO STEPwise approach to chronic disease risk factor surveillance. Heart 2013; 99:1323-9. [PMID: 23872588 DOI: 10.1136/heartjnl-2013-303913] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the distribution of cardiovascular risk factors in western Kenya using a Health and Demographic Surveillance System (HDSS). DESIGN Population based survey of residents in an HDSS. SETTING Webuye Division in Bungoma East District, Western Province of Kenya. PATIENTS 4037 adults ≥ 18 years of age. INTERVENTIONS Home based survey using the WHO STEPwise approach to chronic disease risk factor surveillance. MAIN OUTCOME MEASURES Self-report of high blood pressure, high blood sugar, tobacco use, alcohol use, physical activity, and fruit/vegetable intake. RESULTS The median age of the population was 35 years (IQR 26-50). Less than 6% of the population reported high blood pressure or blood sugar. Tobacco and alcohol use were reported in 7% and 16% of the population, respectively. The majority of the population (93%) was physically active. The average number of days per week that participants reported intake of fruits (3.1 ± 0.1) or vegetables (1.6 ± 0.1) was low. In multiple logistic regression analyses, women were more likely to report a history of high blood pressure (OR 2.72, 95% CI 1.9 to 3.9), less likely to report using tobacco (OR 0.08, 95% CI 0.06 to 0.11), less likely to report alcohol use (OR 0.18, 95% CI 0.15 to 0.21) or eat ≥ 5 servings per day of fruits or vegetables (OR 0.87, 95% CI 0.76 to 0.99) compared to men. CONCLUSIONS The most common cardiovascular risk factors in peri-urban western Kenya are tobacco use, alcohol use, and inadequate intake of fruits and vegetables. Our data reveal locally relevant subgroup differences that could inform future prevention efforts.
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Affiliation(s)
- Gerald S Bloomfield
- Division of Cardiology, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
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Danaei G, Singh GM, Paciorek CJ, Lin JK, Cowan MJ, Finucane MM, Farzadfar F, Stevens GA, Riley LM, Lu Y, Rao M, Ezzati M. The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008. Circulation 2013; 127:1493-502, 1502e1-8. [PMID: 23481623 DOI: 10.1161/circulationaha.113.001470] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND It is commonly assumed that cardiovascular disease risk factors are associated with affluence and Westernization. We investigated the associations of body mass index (BMI), fasting plasma glucose, systolic blood pressure, and serum total cholesterol with national income, Western diet, and, for BMI, urbanization in 1980 and 2008. METHODS AND RESULTS Country-level risk factor estimates for 199 countries between 1980 and 2008 were from a previous systematic analysis of population-based data. We analyzed the associations between risk factors and per capita national income, a measure of Western diet, and, for BMI, the percentage of the population living in urban areas. In 1980, there was a positive association between national income and population mean BMI, systolic blood pressure, and total cholesterol. By 2008, the slope of the association between national income and systolic blood pressure became negative for women and zero for men. Total cholesterol was associated with national income and Western diet in both 1980 and 2008. In 1980, BMI rose with national income and then flattened at ≈Int$7000; by 2008, the relationship resembled an inverted U for women, peaking at middle-income levels. BMI had a positive relationship with the percentage of urban population in both 1980 and 2008. Fasting plasma glucose had weaker associations with these country macro characteristics, but it was positively associated with BMI. CONCLUSIONS The changing associations of metabolic risk factors with macroeconomic variables indicate that there will be a global pandemic of hyperglycemia and diabetes mellitus, together with high blood pressure in low-income countries, unless effective lifestyle and pharmacological interventions are implemented.
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Affiliation(s)
- Goodarz Danaei
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
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Mayosi BM, Forrester T. Commentary: 'serum-cholesterol, diet, and coronary heart-disease in Africans and Asians in Uganda' by AG Shaper and KW Jones. Int J Epidemiol 2013; 41:1233-5. [PMID: 23045199 DOI: 10.1093/ije/dys169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
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Kohler IV, Soldo BJ, Anglewicz P, Chilima B, Kohler HP. Association of blood lipids, creatinine, albumin, and CRP with socioeconomic status in Malawi. Popul Health Metr 2013; 11:4. [PMID: 23448548 PMCID: PMC3701600 DOI: 10.1186/1478-7954-11-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 01/09/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The objective of these analyses is to document the relationship between biomarker-based indicators of health and socioeconomic status (SES) in a low-income African population where the cumulative effects of exposure to multiple stressors on physiological functions and health in general are expected to be highly detrimental for the well-being of individuals. METHODS Biomarkers were collected subsequent to the 2008 round of the Malawi Longitudinal Study of Families and Health (MLSFH), a population-based study in rural Malawi, including blood lipids (total cholesterol, LDL, HDL, ratio of total cholesterol to HDL), biomarkers of renal and liver organ function (albumin and creatinine) and wide-range C-reactive protein (CRP) as a non-specific biomarker for inflammation. These biomarkers represent widely used indicators of health that are individually or cumulatively recognized as risk factors for age-related diseases among prime-aged and elderly individuals. Quantile regressions are used to estimate the age-gradient and the within-day variation of each biomarker distribution. Differences in biomarker levels by socioeconomic status are investigated using descriptive and multivariate statistics. RESULTS Overall, the number of significant associations between the biomarkers and socioeconomic measures is very modest. None of the biomarkers significantly varies with schooling. Except for CRP where being married is weakly associated with lower risk of having an elevated CRP level, marriage is not associated with the biomarkers measured in the MLSFH. Similarly, being Muslim is associated with a lower risk of having elevated CRP but otherwise religion does not predict being in the high-risk quartiles of any of the MLSFH biomarkers. Wealth does not predict being in the high-risk quartile of any of the MLSFH biomarkers, with the exception of a weak effect on creatinine. Being overweight or obese is associated with increased likelihood of being in the high-risk quartile for cholesterol, Chol/HDL ratio, and LDL. CONCLUSIONS The results provide only weak evidence for variation of the biomarkers by socioeconomic indicators in a poor Malawian context. Our findings underscore the need for further research to understand the determinants of health outcomes in a poor low-income context such as rural Malawi.
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Affiliation(s)
- Iliana V Kohler
- Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA
| | - Beth J Soldo
- Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA
| | - Philip Anglewicz
- Department of International Health and Development, Tulane University, 1440 Canal St., New Orleans, LA 70112, USA
| | - Ben Chilima
- Community Health Sciences Unit, Ministry of Health and Population, Private Bag 65, Lilongwe, Malawi
| | - Hans-Peter Kohler
- Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104, USA
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Cardoso I, Bovet P, Viswanathan B, Luke A, Marques-Vidal P. Nutrition transition in a middle-income country: 22-year trends in the Seychelles. Eur J Clin Nutr 2012; 67:135-40. [PMID: 23249880 DOI: 10.1038/ejcn.2012.199] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES There is little objective information regarding nutrition transition in African countries. We assessed trends in nutrition patterns in the Seychelles between 1989 and 2011. SUBJECTS/METHODS Population-based samples were obtained in 1989, 1994 and 2011 and participants aged 25-44 are considered in this study (n=493, 599 and 471, respectively). Similar, although not identical, food frequency questionnaires (FFQs) were used in each survey and the variables were collapsed into homogenous categories for the purpose of this study. RESULTS Between 1989 and 2011, consumption frequency of fish (5+/week) decreased from 93 to 74%, whereas the following increased: meat (5+/week) 25 to 51%, fruits (1+/week) 48 to 94%, salty snacks (1+/week) 22 to 64% and sweet snacks (1+/week) 38 to 67% (P<0.001 for all). Consumption frequency decreased for home-brewed alcoholic drinks (1+/week) 16 to 1%, but increased for wine (1+/week) 5 to 33% (both P<0.001). Between 2004 and 2011, consumption frequency decreased for rice (2/day) 62 to 57% and tea (1+/day) 72 to 68%, increased for poultry (1+/week) 86 to 96% (all P<0.01), and did not change for vegetables (70.3 to 69.8%, P=0.65). CONCLUSIONS Seychelles is experiencing nutrition transition characterized by a decreased consumption frequency of traditional staple foods (fish, polished rice), beverages (tea) and of inexpensive home brews, and increased consumption frequency of meat, poultry and snacks. Food patterns also became more varied along with a broader availability of products in the 22-year interval. The health impact of these changes should be further studied.
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Affiliation(s)
- I Cardoso
- Institute of Preventive Medicine, Lisbon, Portugal
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Stringhini S, Viswanathan B, Gédéon J, Paccaud F, Bovet P. The social transition of risk factors for cardiovascular disease in the African region: evidence from three cross-sectional surveys in the Seychelles. Int J Cardiol 2012. [PMID: 23206526 DOI: 10.1016/j.ijcard.2012.11.064] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To examine the association between socioeconomic status (SES) and several cardiovascular disease risk factors (CVRFs) and to assess whether this association has changed over a 15-year observation period. METHODS Three independent population-based surveys of CVRFs were conducted in representative samples of all adults aged 25-64 years in the Seychelles, a small island state located east to Kenya, in 1989 (N=1081), 1994 (N=1067) and 2004 (N=1255). RESULTS Among men, current smoking and heavy drinking were more prevalent in the low versus the high SES group, and obesity was less prevalent. The socioeconomic gradient in diabetes reversed over the study period from lower prevalence in the low versus the high SES group to higher prevalence in the low SES group. Hypercholesterolemia was less prevalent in the low versus the high SES group in 1989 but the prevalence was similar in the two groups in 2004. Hypertension showed no consistent socioeconomic pattern. Among women, the SES gradient in smoking tended to reverse over time from lower prevalence in the low SES group to lower prevalence in the high SES group. Obesity and diabetes were more common in the low versus the high SES group over the study period. Heavy drinking, hypertension and hypercholesterolemia were not socially patterned among women. CONCLUSION The prevalence of several CVRFs was higher in low versus high SES groups in a rapidly developing country in the African region, and an increase of the burden of these CVRFs in the most disadvantaged groups of the population was observed over the 15 years study period.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland
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Bovet P, Arlabosse T, Viswanathan B, Myers G. Association between obesity indices and cardiovascular risk factors in late adolescence in the Seychelles. BMC Pediatr 2012; 12:176. [PMID: 23134594 PMCID: PMC3507891 DOI: 10.1186/1471-2431-12-176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 11/04/2012] [Indexed: 11/15/2022] Open
Abstract
Background The ability of different obesity indices to predict cardiovascular risk is still debated in youth and few data are available in sub Saharan Africa. We compared the associations between several indices of obesity and cardiovascular risk factors (CVRFs) in late adolescence in the Seychelles. Methods We measured body mass index (BMI), waist circumference, waist/hip ratio (WHiR), waist/height ratio (WHtR) and percent fat mass (by bioimpedance) and 6 CVRFs (blood pressure, LDL-cholesterol, HDL-cholesterol, triglycerides, fasting blood glucose and uric acid) in 423 youths aged 19–20 years from the general population. Results The prevalence of overweight/obesity and several CVRFs was high, with substantial sex differences. Except for glucose in males and LDL-cholesterol in females, all obesity indices were associated with CVRFs. BMI consistently predicted CVRFs at least as well as the other indices. Linear regression on BMI had standardized regression coefficients of 0.25-0.36 for most CVRFs (p<0.01) and ROC analysis had an AUC between 60%-75% for most CVRFs. BMI also predicted well various combinations of CVRFs: 36% of male and 16% of female lean subjects (BMI <P50) had ≥2 CVRFs compared to 74% of male and 46% of female overweight subjects (BMI >P90). Conclusion There was an elevated prevalence of obesity and of several CVRFs in youths in Seychelles. BMI predicted single or combined CVRFs at least as well as other simple obesity indices.
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Affiliation(s)
- Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.
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Association between conventional risk factors and different ultrasound-based markers of atherosclerosis at carotid and femoral levels in a middle-aged population. Int J Cardiovasc Imaging 2012; 29:589-99. [PMID: 23015308 DOI: 10.1007/s10554-012-0124-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 09/03/2012] [Indexed: 02/07/2023]
Abstract
Ultrasound detection of sub-clinical atherosclerosis (ATS) may help identify individuals at high cardiovascular risk. Most studies evaluated intima-media thickness (IMT) at carotid level. We compared the relationships between main cardiovascular risk factors (CVRF) and five indicators of ATS (IMT, mean and maximal plaque thickness, mean and maximal plaque area) at both carotid and femoral levels. Ultrasound was performed on 496 participants aged 45-64 years randomly selected from the general population of the Republic of Seychelles. 73.4 % participants had ≥ 1 plaque (IMT thickening ≥ 1.2 mm) at carotid level and 67.5 % at femoral level. Variance (adjusted R2) contributed by age, sex and CVRF (smoking, LDL-cholesterol, HDL-cholesterol, blood pressure, diabetes) in predicting any of the ATS markers was larger at femoral than carotid level. At both carotid and femoral levels, the association between CVRF and ATS was stronger based on plaque-based markers than IMT. Our findings show that the associations between CVRF and ATS markers were stronger at femoral than carotid level, and with plaque-based markers rather than IMT. Pending comparison of these markers using harder cardiovascular endpoints, our findings suggest that markers based on plaque morphology assessed at femoral artery level might be useful cardiovascular risk predictors.
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Guessous I, Bochud M, Theler JM, Gaspoz JM, Pechère-Bertschi A. 1999-2009 Trends in prevalence, unawareness, treatment and control of hypertension in Geneva, Switzerland. PLoS One 2012; 7:e39877. [PMID: 22761919 PMCID: PMC3384604 DOI: 10.1371/journal.pone.0039877] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/28/2012] [Indexed: 01/13/2023] Open
Abstract
Background There are no time trends in prevalence, unawareness, treatment, and control of hypertension in Switzerland. The objective of this study was to analyze these trends and to determine the associated factors. Methods/Findings Population-based study conducted in the Canton of Geneva, Switzerland, between 1999 and 2009. Blood pressure was measured thrice using a standard protocol. Hypertension was defined as mean systolic or diastolic blood pressure ≥140/90 mmHg or self-reported hypertension or anti-hypertensive medication. Unawareness, untreated and uncontrolled hypertension was determined by questionnaires/blood pressure measurements. Yearly age-standardized prevalences and adjusted associations for the 1999–2003 and 2004–2009 survey periods were reported. The 10-year survey included 9,215 participants aged 35 to 74 years. Hypertension remained stable (34.4%). Hypertension unawareness decreased from 35.9% to 17.7% (P<0.001). The decrease in hypertension unawareness was not paralleled by a concomitant absolute increase in hypertension treatment, which remained low (38.2%). A larger proportion of all hypertensive participants were aware but not treated in 2004–2009 (43.7%) compared to 1999–2003 (33.1%). Uncontrolled hypertension improved from 62.2% to 40.6% between 1999 and 2009 (P = 0.02). In 1999–2003 period, factors associated with hypertension unawareness were current smoking (OR = 1.27, 95%CI, 1.02–1.59), male gender (OR = 1.56, 1.27–1.92), hypercholesterolemia (OR = 1.31, 1.20–1.44), and older age (OR 65–74yrs vs 35–49yrs = 1.56, 1.21–2.02). In 1999–2003 and 2004–2009, obesity and diabetes were negatively associated with hypertension unawareness, high education was associated with untreated hypertension (OR = 1.45, 1.12–1.88 and 1.42, 1.02–1.99, respectively), and male gender with uncontrolled hypertension (OR = 1.49, 1.03–2.17 and 1.65, 1.08–2.50, respectively). Sedentarity was associated with higher risk of hypertension and uncontrolled hypertension in 1999–2003. Conclusions Hypertension prevalence remained stable since 1999 in the canton of Geneva. Although hypertension unawareness substantially decreased, more than half of hypertensive subjects still remained untreated or uncontrolled in 2004–2009. This study identified determinants that should guide interventions aimed at improving hypertension treatment and control.
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Affiliation(s)
- Idris Guessous
- Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Stringhini S, Sinon F, Didon J, Gedeon J, Paccaud F, Bovet P. Declining stroke and myocardial infarction mortality between 1989 and 2010 in a country of the african region. Stroke 2012; 43:2283-8. [PMID: 22700529 DOI: 10.1161/strokeaha.112.658468] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In low- and middle-income countries, the total burden of cardiovascular diseases is expected to increase due to demographic and epidemiological transitions. However, data on cause-specific mortality are lacking in sub-Saharan Africa. Seychelles is one of the few countries in the region where all deaths are registered and medically certified. In this study, we examine trends in mortality for stroke and myocardial infarction (MI) between 1989 and 2010. METHODS Based on vital statistics, we ascertained stroke and MI as the cause of death if appearing in any of the 4 fields for immediate, intermediate, underlying, and contributory causes in death certificates. RESULTS Mortality rates (per 100 000, age-standardized to World Health Organization standard population) decreased from 1669/710 (men/women) in 1989 to 1991 to 1113/535 in 2008-10 for all causes, from 250/140 to 141/86 for stroke, and from 117/51 to 59/24 for MI, corresponding to proportionate decreases of 33%/25% for all-cause mortality, 44%/39% for stroke, and 50%/53% for MI over 22 years. The absolute number of stroke and MI deaths did not increase over time. In 2008 to 2010, the median age of death was 65/78 years (men/women) for all causes, 68/78 for stroke, and 66/73 for MI. CONCLUSIONS Between 1989 and 2010, age-standardized stroke and MI mortality decreased markedly and more rapidly than all-cause mortality. The absolute number of cardiovascular disease deaths did not increase over time because the impact of population aging was fully compensated by the decline in cardiovascular disease mortality. Stroke mortality remained high, emphasizing the need to strengthen cardiovascular disease prevention and control.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland
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Birth weight, weight change, and blood pressure during childhood and adolescence: a school-based multiple cohort study. J Hypertens 2012; 29:1871-9. [PMID: 21881523 DOI: 10.1097/hjh.0b013e32834ae396] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We assessed the association between birth weight, weight change, and current blood pressure (BP) across the entire age-span of childhood and adolescence in large school-based cohorts in the Seychelles, an island state in the African region. METHODS Three cohorts were analyzed: 1004 children examined at age 5.5 and 9.1 years, 1886 children at 9.1 and 12.5, and 1575 children at 12.5 and 15.5, respectively. Birth and 1-year anthropometric data were gathered from medical files. The outcome was BP at age 5.5, 9.1, 12.5 or 15.5 years, respectively. Conditional linear regression analysis was used to estimate the relative contribution of changes in weight (expressed in z-score) during different age periods on BP. All analyses were adjusted for height. RESULTS At all ages, current BP was strongly associated with current weight. Birth weight was not significantly associated with current BP. Upon adjustment for current weight, the association between birth weight and current BP tended to become negative. Conditional linear regression analyses indicated that changes in weight during successive age periods since birth contributed substantially to current BP at all ages. The strength of the association between weight change and current BP increased throughout successive age periods. CONCLUSION Weight changes during any age period since birth have substantial impact on BP during childhood and adolescence, with BP being more responsive to recent than earlier weight changes.
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Relation between high-sensitivity C-reactive protein and cardiovascular and renal markers in a middle-income country in the African region. Int J Cardiol 2011; 156:203-8. [PMID: 22018511 DOI: 10.1016/j.ijcard.2011.09.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 09/01/2011] [Accepted: 09/26/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND High-sensitivity C-reactive protein (hs-CRP) is associated with several cardiovascular risk factors (CVRF) and with renal function markers. However, these associations have not been examined in populations in the African region. We analyzed the distribution of hs-CRP and the relationship with a broad set of CVRF, renal markers and carotid intima-media thickness (IMT), in the Seychelles (African region). METHODS We conducted a survey in the population aged 25-64 years (n=1255, participation rate: 80.2%). Analyses were restricted to persons of predominantly African descent (n=1011). RESULTS Mean and median hs-CRP serum concentrations (mg/l) were 3.1 (SD 7.6) and 1.4 (IQR 0.7-2.9) in men and 4.5 (SD 6.7) and 2.2 (IQR 1.0-5.4) in women (p<0.001 for difference between men and women). hs-CRP was significantly associated with several conventional CVRF, and particularly strongly with markers of adiposity. With regards to renal markers, hs-CRP was strongly associated with cystatin C and with microalbuminuria but not with creatinine. hs-CRP was not associated with IMT. CONCLUSIONS Serum concentration of hs-CRP was significantly associated with sex, several CVRF and selected renal function markers, which extends similar findings in Europe and in North America to a population in the African region. These findings can contribute to guide recommendations for the use of hs-CRP in clinical practice in the region.
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Martínez-Vizcaino V, Ortega FB, Solera-Martínez M, Ruiz JR, Labayen I, Eensoo D, Harro J, Loit HM, Veidebaum T, Sjöström M. Stability of the factorial structure of metabolic syndrome from childhood to adolescence: a 6-year follow-up study. Cardiovasc Diabetol 2011; 10:81. [PMID: 21933439 PMCID: PMC3193025 DOI: 10.1186/1475-2840-10-81] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 09/21/2011] [Indexed: 12/13/2022] Open
Abstract
Background Metabolic syndrome (MS) is a clustering of cardiometabolic risk factors that is considered a predictor of cardiovascular disease, type 2 diabetes and mortality. There is no consistent evidence on whether the MS construct works in the same way in different populations and at different stages in life. Methods We used confirmatory factor analysis to examine if a single-factor-model including waist circumference, triglycerides/HDL-c, insulin and mean arterial pressure underlies metabolic syndrome from the childhood to adolescence in a 6-years follow-up study in 174 Swedish and 460 Estonian children aged 9 years at baseline. Indeed, we analyze the tracking of a previously validated MS index over this 6-years period. Results The estimates of goodness-of-fit for the single-factor-model underlying MS were acceptable both in children and adolescents. The construct stability of a new model including the differences from baseline to the end of the follow-up in the components of the proposed model displayed good fit indexes for the change, supporting the hypothesis of a single factor underlying MS component trends. Conclusions A single-factor-model underlying MS is stable across the puberty in both Estonian and Swedish young people. The MS index tracks acceptably from childhood to adolescence.
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Diet, the Global Obesity Epidemic, and Prevention. ACTA ACUST UNITED AC 2011; 111:1137-40. [DOI: 10.1016/j.jada.2011.05.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 04/26/2011] [Indexed: 11/22/2022]
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Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, Lin JK, Farzadfar F, Khang YH, Stevens GA, Rao M, Ali MK, Riley LM, Robinson CA, Ezzati M. 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; 378:31-40. [PMID: 21705069 DOI: 10.1016/s0140-6736(11)60679-x] [Citation(s) in RCA: 2400] [Impact Index Per Article: 184.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Data for trends in glycaemia and diabetes prevalence are needed to understand the effects of diet and lifestyle within populations, assess the performance of interventions, and plan health services. No consistent and comparable global analysis of trends has been done. We estimated trends and their uncertainties in mean fasting plasma glucose (FPG) and diabetes prevalence for adults aged 25 years and older in 199 countries and territories. METHODS We obtained data from health examination surveys and epidemiological studies (370 country-years and 2·7 million participants). We converted systematically between different glycaemic metrics. For each sex, we used a Bayesian hierarchical model to estimate mean FPG and its uncertainty by age, country, and year, accounting for whether a study was nationally, subnationally, or community representative. FINDINGS In 2008, global age-standardised mean FPG was 5·50 mmol/L (95% uncertainty interval 5·37-5·63) for men and 5·42 mmol/L (5·29-5·54) for women, having risen by 0·07 mmol/L and 0·09 mmol/L per decade, respectively. Age-standardised adult diabetes prevalence was 9·8% (8·6-11·2) in men and 9·2% (8·0-10·5) in women in 2008, up from 8·3% (6·5-10·4) and 7·5% (5·8-9·6) in 1980. The number of people with diabetes increased from 153 (127-182) million in 1980, to 347 (314-382) million in 2008. We recorded almost no change in mean FPG in east and southeast Asia and central and eastern Europe. Oceania had the largest rise, and the highest mean FPG (6·09 mmol/L, 5·73-6·49 for men; 6·08 mmol/L, 5·72-6·46 for women) and diabetes prevalence (15·5%, 11·6-20·1 for men; and 15·9%, 12·1-20·5 for women) in 2008. Mean FPG and diabetes prevalence in 2008 were also high in south Asia, Latin America and the Caribbean, and central Asia, north Africa, and the Middle East. Mean FPG in 2008 was lowest in sub-Saharan Africa, east and southeast Asia, and high-income Asia-Pacific. In high-income subregions, western Europe had the smallest rise, 0·07 mmol/L per decade for men and 0·03 mmol/L per decade for women; North America had the largest rise, 0·18 mmol/L per decade for men and 0·14 mmol/L per decade for women. INTERPRETATION Glycaemia and diabetes are rising globally, driven both by population growth and ageing and by increasing age-specific prevalences. Effective preventive interventions are needed, and health systems should prepare to detect and manage diabetes and its sequelae. FUNDING Bill & Melinda Gates Foundation and WHO.
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Affiliation(s)
- Goodarz Danaei
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, Goldberg AC, Howard WJ, Jacobson MS, Kris-Etherton PM, Lennie TA, Levi M, Mazzone T, Pennathur S. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2011; 123:2292-333. [PMID: 21502576 DOI: 10.1161/cir.0b013e3182160726] [Citation(s) in RCA: 1261] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Danaei G, Finucane MM, Lin JK, Singh GM, Paciorek CJ, Cowan MJ, Farzadfar F, Stevens GA, Lim SS, Riley LM, Ezzati M. 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; 377:568-77. [PMID: 21295844 DOI: 10.1016/s0140-6736(10)62036-3] [Citation(s) in RCA: 711] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Data for trends in blood pressure are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. However, few worldwide analyses of trends in blood pressure have been done. We estimated worldwide trends in population mean systolic blood pressure (SBP). METHODS We estimated trends and their uncertainties in mean SBP for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (786 country-years and 5·4 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean SBP by age, country, and year, accounting for whether a study was nationally representative. FINDINGS In 2008, age-standardised mean SBP worldwide was 128·1 mm Hg (95% uncertainty interval 126·7-129·4) in men and 124·4 mm Hg (123·0-125·9) in women. Globally, between 1980 and 2008, SBP decreased by 0·8 mm Hg per decade (-0·4 to 2·2, posterior probability of being a true decline=0·90) in men and 1·0 mm Hg per decade (-0·3 to 2·3, posterior probability=0·93) in women. Female SBP decreased by 3·5 mm Hg or more per decade in western Europe and Australasia (posterior probabilities ≥0·999). Male SBP fell most in high-income North America, by 2·8 mm Hg per decade (1·3-4·5, posterior probability >0·999), followed by Australasia and western Europe where it decreased by more than 2·0 mm Hg per decade (posterior probabilities >0·98). SBP rose in Oceania, east Africa, and south and southeast Asia for both sexes, and in west Africa for women, with the increases ranging 0·8-1·6 mm Hg per decade in men (posterior probabilities 0·72-0·91) and 1·0-2·7 mm Hg per decade for women (posterior probabilities 0·75-0·98). Female SBP was highest in some east and west African countries, with means of 135 mm Hg or greater. Male SBP was highest in Baltic and east and west African countries, where mean SBP reached 138 mm Hg or more. Men and women in western Europe had the highest SBP in high-income regions. INTERPRETATION On average, global population SBP decreased slightly since 1980, but trends varied significantly across regions and countries. SBP is currently highest in low-income and middle-income countries. Effective population-based and personal interventions should be targeted towards low-income and middle-income countries. FUNDING Funding Bill & Melinda Gates Foundation and WHO.
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Affiliation(s)
- Goodarz Danaei
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Farzadfar F, Finucane MM, Danaei G, Pelizzari PM, Cowan MJ, Paciorek CJ, Singh GM, Lin JK, Stevens GA, Riley LM, Ezzati M. 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; 377:578-86. [PMID: 21295847 DOI: 10.1016/s0140-6736(10)62038-7] [Citation(s) in RCA: 389] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Data for trends in serum cholesterol are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. Previous analyses of trends in serum cholesterol were limited to a few countries, with no consistent and comparable global analysis. We estimated worldwide trends in population mean serum total cholesterol. METHODS We estimated trends and their uncertainties in mean serum total cholesterol for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (321 country-years and 3·0 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean total cholesterol by age, country, and year, accounting for whether a study was nationally representative. FINDINGS In 2008, age-standardised mean total cholesterol worldwide was 4·64 mmol/L (95% uncertainty interval 4·51-4·76) for men and 4·76 mmol/L (4·62-4·91) for women. Globally, mean total cholesterol changed little between 1980 and 2008, falling by less than 0·1 mmol/L per decade in men and women. Total cholesterol fell in the high-income region consisting of Australasia, North America, and western Europe, and in central and eastern Europe; the regional declines were about 0·2 mmol/L per decade for both sexes, with posterior probabilities of these being true declines 0·99 or greater. Mean total cholesterol increased in east and southeast Asia and Pacific by 0·08 mmol/L per decade (-0·06 to 0·22, posterior probability=0·86) in men and 0·09 mmol/L per decade (-0·07 to 0·26, posterior probability=0·86) in women. Despite converging trends, serum total cholesterol in 2008 was highest in the high-income region consisting of Australasia, North America, and western Europe; the regional mean was 5·24 mmol/L (5·08-5·39) for men and 5·23 mmol/L (5·03-5·43) for women. It was lowest in sub-Saharan Africa at 4·08 mmol/L (3·82-4·34) for men and 4·27 mmol/L (3·99-4·56) for women. INTERPRETATION Nutritional policies and pharmacological interventions should be used to accelerate improvements in total cholesterol in regions with decline and to curb or prevent the rise in Asian populations and elsewhere. Population-based surveillance of cholesterol needs to be improved in low-income and middle-income countries. FUNDING Bill & Melinda Gates Foundation and WHO.
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Affiliation(s)
- Farshad Farzadfar
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
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Franco M, Cooper RS, Bilal U, Fuster V. Challenges and opportunities for cardiovascular disease prevention. Am J Med 2011; 124:95-102. [PMID: 21295188 DOI: 10.1016/j.amjmed.2010.08.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 08/24/2010] [Accepted: 08/27/2010] [Indexed: 11/27/2022]
Abstract
Cardiovascular diseases are highly preventable, yet they remain the most common cause of death in the world. The epidemic is receding in industrialized countries; however, many low-income and middle-income countries have experienced an increase in cardiovascular diseases and 80% of all cardiovascular diseases deaths occur there. In the last 20 years, the epidemiology and surveillance of cardiovascular diseases have laid the foundations for public health interventions that may reduce the burden of disease. Relevant population-specific local data are therefore needed to describe the trends and pattern of risk for atherosclerotic diseases. Once the basis for surveillance and epidemiological research has been laid, cardiovascular disease prevention will require approaches adapted for each individual and population. The existence of effective preventive interventions justifies the assertion that coronary heart disease and stroke could be virtually prevented and controlled. Our goal in this review is to summarize the current challenges and opportunities for cardiovascular medicine, focusing on the need for high-quality local surveillance systems that provide the appropriate data needed to develop sound national cardiovascular disease preventive policies.
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Affiliation(s)
- Manuel Franco
- Department of Epidemiology, Atherothrombosis and Imaging, National Center for Cardiovascular Research, Madrid, Spain
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Bovet P, Viswanathan B, Shamlaye C, Romain S, Gedeon J. Addressing non-communicable diseases in the Seychelles: towards a comprehensive plan of action. Glob Health Promot 2010; 17:37-40. [PMID: 20595339 DOI: 10.1177/1757975910363930] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article reviews the different steps taken during the past 20 years for the prevention and control of non-communicable diseases (NCDs) in the Seychelles. National surveys revealed high levels of several cardiovascular risk factors and prompted an organized response, starting with the creation of an NCD unit in the Ministry of Health. Information campaigns and nationwide activities raised awareness and rallied increasingly broad and high-level support. Significant policy was developed including comprehensive tobacco legislation and a School Nutrition Policy that bans soft drinks in schools. NCD guidelines were developed and specialized 'NCD nurses' were trained to complement doctors in district health centers. Decreasing smoking prevalence is evidence of success, but the raising so-called diabesity epidemic calls for an integrated multi-sector policy to mould an environment conducive to healthy behaviors. Essential components of these efforts include: effective surveillance mechanisms supplemented by focused research; generating broad interest and consensus; mobilizing leadership and commitment at all levels; involving local and international expertise; building on existing efforts; and seeking integrated, multi-disciplinary and multi-sector approaches.
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Affiliation(s)
- Pascal Bovet
- Ministry of Health and Social Development, Victoria, Republic of Seychelles.
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