The Prevalence of Cardiovascular Diseases and associated factors among patients in Low- and Middle-Income settings

Authors

  • SAMWEL JACOB RWEYEMAMU JAKAYA KIKWETE CARDIAC INSTITUTE(JKCI)
  • DR Longopa JKCI
  • SR Bishashara JKCI
  • SR Rosemary JKCI
  • DR. Mutagaywa MUHAS
  • DR. Waane JKCI
  • DR.Kisenge JKCI

DOI:

https://doi.org/10.14738/aivp.102.11899

Keywords:

cardiovascular Disaeses in Southern Part of Tanzania, associate factors for CVD in LMIC

Abstract

Background

 Cardiovascular Diseases (CVDs) are the public health problems worldwide, causing over 18.9 million deaths per year. The major risk factors which are also preventable are tobacco use, diabetes, high blood pressure, overweight/ obesity and alcohol consumption.

The aim of this study was to determine the Prevalence of CVDs and associated factors.

Methodology

We conducted a cross-sectional hospital-based study that consecutively enrolled 785 consenting adults who came to attend Jakaya Kikwete Cardiac Institute (JKCI) mobile clinic in South Western urban Tanzania, a typical LMIC, in 2018. A structured questionnaire was used to obtain demographic data and gather several co-morbid information. A 12 lead Electrocardiogram (ECG) and 2D, M mode Transthoracic Echocardiogram were done to determine the structural and none structural heart diseases from the participants.

Results

 Of 785 participants, 528 (67.3 %) were females, 479 (61%) were middle aged (40-60 years) and 196 (25%) were 65 years old and above, their mean age (±SD) was 56 (±14) years. Most of participants were married 558 (71%), 625 (80%) sponsored by the National Health Insurance Fund (NHIF) and less than half were employed.

Of all the participants, tobacco users were 29(3.6%), diabetics 60 (7.5%), alcoholic users 99 (12.5%) and more than half were overweight/obese. The prevalence of Systolic Hypertension was 65% and Diastolic Hypertension was 50%

Few participants 85 (11%) had chest pain, 56 (7%) had tachycardia and difficulty in breathing 45 (6%). By ECHO diagnosis; the prevalence of dilated cardiomyopathy was 3.8%, hypertensive heart diseases 2.3% and valvular heart diseases was 2%. Majority 780 (99%) and 694 (88%) had normal Left Ventricular Systolic and Diastolic functions respectively. Furthermore, by ECG diagnosis, the prevalence of Left Ventricular Hypertrophy was 8% and ischemic heart disease was diagnosed in 4% of the participants.

In a multivariate analysis, CVD were found to be statistically significant associated with the age 65+ years, 3.41 [95% CI 1.49 -7.78, p- value 0.004], diastolic blood pressure above or equal to 90 mmHg, 1.61 [95% CI 1.05 -2.48, p -value 0.03] and overweight/ obese 1.94 [95% CI 1.28 -2.92, p-value 0.002].

Conclusion

The prevalence of cardiovascular diseases was found to be high and the main associated risk factors were advanced age, overweight/obese and diastolic hypertension. Some of the participants had already developed asymptomatic structural heart disease and features which were suggesting of coronary artery diseases. 

Recommendations

Efforts for an early detection of CVD should be undertaken in order to offer an early and appropriate interventions

Author Biographies

DR Longopa, JKCI

Cardiologist  at JKCI

SR Bishashara, JKCI

ANO at JKCI

DR. Waane, JKCI

Cradiologist at JKCI

DR.Kisenge, JKCI

cardiologist at JKCI

References

Kaptoge S, Pennells L, De Bacquer D, Cooney MT, Kavousi M, Stevens G, et al. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Heal. 2019;7(10):e1332–45.

Callender T, Woodward M, Roth G, Farzadfar F, Lemarie JC, Gicquel S, et al. Heart failure care in low- and middle-income countries: A systematic review and meta-analysis. PLoS Med. 2015;11(8).

Roth GA, Huffman MD, Moran AE, Feigin V, Mensah GA, Naghavi M, et al. Global and regional patterns in cardiovascular mortality from 1990 to 2013. Circulation. 2015;132(17):1667–78.

Hamo CE, Bloom MW. Cancer and Heart Failure: Understanding the Intersection. Card Fail Rev [Internet]. 2017;23(11):66–70.

Mohamed AA, Fourie JM, Scholtz W, Scarlatescu O, Nel G, Subahi S. Sudan Country Report PASCAR and WHF Cardiovascular Diseases Scorecard project. 2019;30(5):305–10.

Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736–88.

Truong UT, Maahs DM, Daniels SR. Cardiovascular Disease in Children and Adolescents with Diabetes: Where Are We, and Where Are We Going? Diabetes Technol Ther [Internet]. 2012;14(S1):S-11-S-21.

Soltesz G, Patterson CC, Dahlquist G. Worldwide childhood type 1 diabetes incidence - What can we learn from epidemiology? Pediatr Diabetes. 2007;8(SUPPL. 6):6–14.

Enos WF. Landmark article, July 18, 1953: Coronary disease among United States soldiers killed in action in Korea. Preliminary report. By William F. Enos, Robert H. Holmes and James Beyer. JAMA J Am Med Assoc. 1953;(152):1090–3.

Berenson GS, Srinivasan SR, Bao W, Newman W, Tracy RE, Wattigney WA, et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998;338(23):1650–3.

Strong JP, Malcom GT, McMahan CA, Tracy RE, Newman WP, Herderick EE, et al. Prevalence and extent of atherosclerosis in adolescents and young adults: Implications for prevention from the pathobiological determinants of atherosclerosis in youth study. J Am Med Assoc. 1999;(281):727–35.

Mendis S, Nordet P, Fernandez-Britto JE, Sternby N. Atherosclerosis in children and young adults: An overview of the World Health Organization and International Society and Federation of Cardiology study on Pathobiological Determinants of Atherosclerosis in Youth study (1985-1995). Prev Control. 2005;1(1):3–15.

Zieske AW, Malcom GT, Strong JP. Natural history and risk factors of atherosclerosis in children and youth: The PDAY study. Pediatr Pathol Mol Med. 2002;21(2):213–237.

Susan P. Bell, MBBS, MSCI and Avantika Saraf M. Risk stratification in very old adults: How to best gauge risk as the basis of management choices for patients aged over 80. Prog Cardiovasc Dis. 2009;6(2):247–53.

Alan S. Go, MD, Dariush Mozaffarian, MD, DrPH, FAHA, Véronique L. Roger, MD, MPH, FAHA, Emelia J. Benjamin, MD, ScM F. Heart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association WRITING. Circulation. 2013;127(1):e6–e245.

Journal C. PASCAR. Vol. 31, Cardiovascular Journal of Africa • Volume 31, No 4 August 2020. 2020. p. www.cvja.co.za.

Rodgers JL, Jones J, Bolleddu SI, Vanthenapalli S, Rodgers LE, Shah K, et al. Cardiovascular Risks Associated with Gender and Aging. J Cardiovasc Dev Dis. 2019;6(2):19.

Roman WP, Martin HD, Sauli E. Cardiovascular diseases in Tanzania : The burden of modifiable and intermediate risk factors. J Xiangya Med. 2019;(6):4–33.

WHO. WHO Report on Global Tobacco Epidemic 2017. World Health Organization. 2019.

World Health Organization. WHO report on the global tobacco epidemic, 2017 Country Profile: United Republic of Tanzania. Ctry case Stud Synth. 2006;

Health MOF, Medical NFOR. Tanzania Steps Survey Report Ministry of Health and Social Nationalinstitute for Medical in Collaboration With World Health. 2013;

Kapito-Tembo A, Muula AS, Rudatsikira E, Siziya S. Smoking among in-school adolescents in Dar es Salaam, Tanzania: Results from the Global Youth Tobacco Survey. Tanzan J Health Res. 2011;13.

Kagaruki G. Tanzania Steps Survey Report. Ministry of Health and Social Welfare, and National Institute for Medical Research (NIMR) in Collaboration With World Health Organiztion. 2013.

Rweyemamu SJ, Nchimbi H, Ramaiya K, Mayala HA. Prevalence of Cardiovascular Disease and Risk Factors Among Residents of Tanga City. 2020;(4).

Mandha J, Buza J, Kassimu N, Petrucka P. Prevalence of Hypertension and Associated Risk Factors among Maasai Communities in Simanjiro , Tanzania. Sci Int www.sciencedomain.org. 2015;2(2):96–108.

Malmberg K, Båvenholm P, Hamsten a. Clinical and biochemical factors associated with prognosis after myocardial infarction at a young age. J Am Coll Cardiol. 1994;24(3):592–9.

Goh LG, Dhaliwal SS, Lee AH, Bertolatti D, Della PR. Utility of established cardiovascular disease risk score models for the 10-year prediction of disease outcomes in women. Expert Rev Cardiovasc Ther [Internet]. 2013;11(4):425–35.

Perk J, De Backer G, Gohlke H, Graham I, Reiner Ž, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J. 2012;33(13):1635–701.

Kapito-tembo A. Tnzaniaanzania Demographic and Health Survey 2016. Natl Bur Stat Dar es Salaam, Tanzania ICF Macro Calverton, Maryland, USA. 20116;1-482.

Govindan R, Page N, Morgensztern D, Read W, Tierney R, Vlahiotis A, et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol [Internet]. 2006;24(28):4539–44.

R. M, V. C. Peripheral arterial disease and diabetes. Vnitr Lek [Internet]. 2010;56(4):341–6.

Stanifer JW, Cleland CR, Makuka GJ, Egger R, Maro V, Maro H, et al. Prevalence , Risk Factors , and Complications of Diabetes in the Kilimanjaro Region : A Population-Based Study from Tanzania. PLoS One. 2016;.(11:e0164428.):1–13.

International Diabetes Federation. Diabetes and Cardiovascular Disease. Idf. 2016;5(1):11–8.

Zubery D, Kimiywe J, Martin HD. Prevalence of overweight and obesity, and its associated factors among health-care workers, teachers, and bankers in Arusha City, Tanzania. Diabetes, Metab Syndr Obes Targets Ther. 2021;14:455–65.

Galson SW, Staton CA, Karia F, Kilonzo K, Lunyera J, Patel UD, et al. Epidemiology of hypertension in Northern Tanzania: a community-based mixed-methods study. BMJ Open [Internet]. 2017;7(11):e018829.

Klatsky AL, Friedman GD, Siegelaub AB, Gerard MJ. Alcohol consumption and blood pressure Kaiser-Permanente Multiphasic Health Examination data. N Engl J Med. 1977;296(21):1194–200.

Banki NM, Chan SL, Rao VA, Melles RB, Bhatt DL. Effect of Systolic and Diastolic Blood Pressure on Cardiovascular Outcomes. new Engl J o f Med. 2019;381:243–51.

Dias, Vera Junn, Eunsung Mouradian MM. Prevalence of Heart Failure Signs and Symptoms in a Large Primary Care Population Identified Through the Use of Text and Data Mining of the Electronic Health Record. J Card Fail. 2014;20(7):459–64.

Furberg CD, Manolio TA, Psaty BM, Bild DE, Borhani NO, Newman A, et al. Major electrocardiographic abnormalities in persons aged 65 years and older (the Cardiovascular Health Study). Am J Cardiol. 1992;15(69(16)):1329–35.

Nyombi K V., Kizito S, Mukunya D, Nabukalu A, Bukama M, Lunyera J, et al. High prevalence of hypertension and cardiovascular disease risk factors among medical students at Makerere University College of Health Sciences, Kampala, Uganda. BMC Res Notes [Internet]. 2016;9(1):110.

Bitton A, Gaziano T. The Framingham Heart Study’s impact on global risk assessment. Prog Cardiovasc Dis. 2010;53(1):68–78.

Correction: 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Heart Rhythm. 2018.

Yazdanyar A. The Burden of Cardiovascular Disease in the Elderly: Morbidity,Mortality, and Costs. Clin Geriatr Med. 2009;25(4):563.

The ALLHAT Officers. Major Outcomes in High-Risk Hypertensive Patients Randomized to or Calcium Channel Blocker vs Diuretic. J Am Med Assoc. 2002;288(23):2981–97.

Makubi A, Hage C, Sartipy U, Lwakatare J, Janabi M, Kisenge P, et al. Heart failure in Tanzania and Sweden: Comparative characterization and prognosis in the Tanzania Heart Failure (TaHeF) study and the Swedish Heart Failure Registry (SwedeHF). Int J Cardiol. 2016;220:750–8.

Downloads

Published

2022-04-16

How to Cite

RWEYEMAMU, S. J., Longopa, G. L. ., Bishashara, S. ., Mpellah, R. G., Mutagaywa, R. ., Waane, T. ., & Kisenge, P. R. . (2022). The Prevalence of Cardiovascular Diseases and associated factors among patients in Low- and Middle-Income settings . European Journal of Applied Sciences, 10(2), 362–379. https://doi.org/10.14738/aivp.102.11899