Risk Factors for Cardiovascular Diseases in Rural Uganda

Abstract

Background: Cardiovascular diseases (CVDs) are on the rise in sub-Saharan Africa (SSA). It is estimated that there were nearly 1 million deaths due to CVDs in 2013, representing an 81% increase relative to 1990 (1). Driving this rapid emergence of CVD as an increasingly important cause of morbidity and premature death in SSA is the convergence of population ageing, changes in diet and lifestyles, urbanization and socio-economic transition (2) (3). In a setting where the average per capita health expenditure (2014) is $198.00 compared to $4,701.00 (constant international dollars, 2011 purchasing power parity (PPP)) in OECD countries (3), for example, it is imperative to prioritize cost-effective interventions to mitigate the challenge posed by CVD. Unlike the West, where massive investments in therapeutic interventions have underwritten improvements in CVD outcomes (3), countries in SSA may have to prioritize preventative strategies. Further, the limited available evidence (4) indicates that SSA`s CVD problem may be qualitatively different – in terms of risk factors, clinical features and treatment outcomes - from the experience in the resource-rich West, potentially limiting the transferability of interventions developed in the West. Overall, the evidence base to inform data-driven, locally relevant regional and national health policies remains very thin. This represents an urgent need to gain better understanding of the profile, magnitude and trends of CVD risk in SSA. Objective: The aim of the two (2) papers was, therefore, to examine the risk factors for CVD in a community-based, general population in rural Uganda. In the first paper, we sought to leverage resting electrocardiography (ECG) as a low-cost, non-invasive technology with potential for assessing CVD risk in low-income settings (5). Specifically, we described the prevalence and characteristics of prolonged QT interval. This is an ECG abnormality known to be independently predictive of major cardiovascular adverse events but is underreported in SSA. The second paper aimed to apply the American Heart Association`s ideal cardiovascular health (iCVH) (6) constructs to define and measure CVD risk factor occurrence in rural Uganda, from a social determinants of health approach, with the ultimate goal of preventing CVD disease.