title: Electrocardiographic assessment of coronary artery disease and stroke risk factors in rural and urban Tanzania: a case-control study.
abstract: BACKGROUND
  Although the association between cerebrovascular and coronary artery disease (CAD) is well known in high-income countries, this association is not well documented in black Africans.
  
  
  OBJECTIVE
  The aim of this study was to document electrocardiographic (ECG) evidence of CAD in stroke cases and controls and to identify other common ECG abnormalities related to known stroke risk factors in a community-based population of incident stroke cases in Tanzania, East Africa.
  
  
  METHODS
  This was a case-control study. Incident stroke cases were identified by the Tanzanian Stroke Incidence Project. Age- and sex-matched controls were randomly selected from the background population. Electrocardiograms were manually analyzed using the Minnesota Coding System, looking for evidence of previous myocardial infarction (MI), atrial fibrillation (AF) or atrial flutter (AFl), and left ventricular hypertrophy (LVH).
  
  
  RESULTS
  In Hai, there were 93 cases and 241 controls with codable electrocardiograms, and in Dar-es-Salaam, there were 39 cases and 72 controls with codable electrocardiograms. Comparing cases and controls, there was a higher prevalence of MI and AF or AFl (but not LVH) in cases compared with controls.
  
  
  CONCLUSIONS
  This is the first published study of ECG assessment of CAD and other stroke risk factors in an incident population of stroke cases in sub-Saharan Africa. It suggests that concomitant CAD in black African stroke cases is more common than previously suggested.
authors.affiliation: Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, UK; Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK. Electronic address: Richard.walker@nhct.nhs.uk.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Walker
authors.affiliation: Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, UK; Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dewhurst
authors.affiliation: Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, UK.
authors.forename: William K
authors.initials: WK
authors.lastname: Gray
authors.affiliation: Department of Radiology, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Jusabani
authors.affiliation: Department of Neurology, Muhimbili University Hospital, Dar-es-Salaam, United Republic of Tanzania.
authors.forename: Eric
authors.initials: E
authors.lastname: Aris
authors.affiliation: Faculty of Medical Sciences, Cave Hill Campus, University of the West Indies, Barbados.
authors.forename: Nigel
authors.initials: N
authors.lastname: Unwin
authors.affiliation: Department of Radiology, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania.
authors.forename: Mark
authors.initials: M
authors.lastname: Swai
authors.affiliation: Department of Cardiology, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Adams
authors.affiliation: Department of Medicine, Muhimbili University College Hospital, Dar-es-Salaam, United Republic of Tanzania.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mugusi
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000208:ethnology; D001282:Atrial Flutter / Q000175:diagnosis / Q000208:ethnology; D044383:Black People; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000208:ethnology*; D003906:Developing Countries; D004562:Electrocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000208:ethnology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000208:ethnology; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012423:Rural Health; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology*; D013636:Tanzania / Q000453:epidemiology; D014504:Urban Health
keywords: Electrocardiography; Tanzania; coronary artery disease; stroke; sub-Saharan Africa
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