title: Scarcity of atrial fibrillation in a traditional African population: a community-based study.
abstract: BACKGROUND
  In western societies, atrial fibrillation is an increasingly common finding among the elderly. Established risk factors of atrial fibrillation include obesity, diabetes, hypertension, and cardiovascular disease. Atrial fibrillation has almost exclusively been studied in western populations where these risk factors are widely present. Therefore, we studied the epidemiology of atrial fibrillation in a traditional African community.
  
  
  METHODS
  In rural Ghana, among 924 individuals aged 50 years and older, we recorded electrocardiograms to detect atrial fibrillation. As established risk factors, we documented waist circumference, body mass index (BMI), capillary glucose level, blood pressure, and electrocardiographic myocardial infarction. In addition, we determined circulating levels of interleukin-6 (IL6), a proinflammatory cytokine, and C-reactive protein (CRP), a marker of systemic inflammation. We compared the risk factors with reference data from the USA.
  
  
  RESULTS
  Atrial fibrillation was detected in only three cases, equalling 0.3% (95% CI 0.1-1.0%). Waist circumference, BMI, and capillary glucose levels were very low. Hypertension and myocardial infarction were uncommon. Circulating levels of IL6 were similar, but those of CRP were lower compared with the USA.
  
  
  CONCLUSIONS
  Atrial fibrillation is very scarce in this traditional African community. Its low prevalence compared with western societies can be explained by the rareness of its established risk factors, which are closely related to lifestyle, and by possible unmeasured differences in other risk factors or genetic factors.
authors.affiliation: Department of Gerontology and Geriatrics, Postal zone C7-Q, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands. j.j.e.koopman@lumc.nl.
authors.forename: Jacob J E
authors.initials: JJ
authors.lastname: Koopman
authors.forename: David
authors.initials: D
authors.lastname: van Bodegom
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
authors.forename: Johan Wouter
authors.initials: JW
authors.lastname: Jukema
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis / Q000208:ethnology* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D044383:Black People; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D004562:Electrocardiography; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D002097:C-Reactive Protein