Markers of Atherosclerosis, Clinical Characteristics, and Treatment Patterns in Heart Failure: A Case-Control Study of Middle-Aged Adult Heart Failure Patients in Rural Kenya.
BACKGROUND
Although risk factors for heart failure are increasingly common worldwide, the contribution of atherosclerosis to heart failure in sub-Saharan Africa is largely unknown.


OBJECTIVE
This study assessed the association between atherosclerotic risk factors and heart failure in a developing country.


METHODS
We performed a case-control study of heart failure in rural Kenya. We assessed the risk factors for heart failure by using international criteria based on electrocardiogram (ECG), echocardiogram, physical examination findings, and laboratory testing. Atherosclerotic risk factors were determined by ECG, echocardiogram, ankle-brachial index (ABI), and lipid testing. We described the relationship of wall motion abnormalities on echocardiogram, ABI <0.9, and ischemic pattern on ECG with the presence of heart failure with multivariable logistic regression adjusting for age and sex and using adjusted odds ratios (AORs) and 95% confidence intervals (CIs).


RESULTS
There were 125 cases and 191 controls (n = 316); 49% were male. The mean age was 60 (SD = 13) years. Most patients had hypertension (53%), and 16% had human immunodeficiency virus infection. Lipids were in the normal range for all. Cases were older than controls (62 years vs. 58 years, respectively). The most common abnormality associated with heart failure was dilated cardiomyopathy. Ischemic heart failure was the second most common cause in men. Cases were more likely to have an ABI <0.9 (46% vs. 31%; AOR: 1.99; 95% CI: 1.19 to 3.32), ischemia or infarct on ECG (68% vs. 43%; AOR: 3.01; 95% CI: 1.43 to 6.34), and wall motion abnormalities on echocardiogram (54% vs. 15%; AOR: 7.00; 95% CI: 3.95 to 12.39).


CONCLUSIONS
Ischemic heart failure is more common in Kenya than previously recognized. Noninvasive markers of atherosclerosis are routinely found among patients with heart failure. Treatment and prevention of heart failure in sub-Saharan Africa must consider many causes including those related to atherosclerosis.
Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA. Electronic address: gerald.bloomfield@duke.edu.
Gerald S
GS
Bloomfield
Center for Statistical Science, School of Public Health, Brown University, Providence, RI, USA.
Allison K
AK
DeLong
Division of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya.
Constantine O
CO
Akwanalo
Department of Biostatistics and Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA.
Joseph W
JW
Hogan
Division of Infectious Diseases, Alpert School of Medicine at Brown University, Providence, RI, USA; Division of Pulmonary Medicine, Alpert School of Medicine at Brown University, Providence, RI, USA.
E Jane
EJ
Carter
Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Daniel F
DF
Aswa
Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
Cynthia
C
Binanay
Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya.
Myra
M
Koech
Division of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya; Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
Sylvester
S
Kimaiyo
Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
Eric J
EJ
Velazquez
D000368:Aged; D055109:Ankle Brachial Index; D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D015415:Biomarkers; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D016022:Case-Control Studies; D050171:Dyslipidemias / Q000150:complications; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000150:complications; D007630:Kenya; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012424:Rural Population
D015415:Biomarkers