title: Cardiovascular Disease Risk Factors in Ghana during the Rural-to-Urban Transition: A Cross-Sectional Study.
abstract: Populations in sub-Saharan Africa are shifting from rural to increasingly urban. Although the burden of cardiovascular disease is expected to increase with this changing landscape, few large studies have assessed a wide range of risk factors in urban and rural populations, particularly in West Africa. We conducted a cross-sectional, population-based survey of 3317 participants from Ghana (≥18 years old), of whom 2265 (57% female) were from a mid-sized city (Sunyani, population ~250,000) and 1052 (55% female) were from surrounding villages (populations <5000). We measured canonical cardiovascular disease risk factors (BMI, blood pressure, fasting glucose, lipids) and fibrinolytic markers (PAI-1 and t-PA), and assessed how their distributions and related clinical outcomes (including obesity, hypertension and diabetes) varied with urban residence and sex. Urban residence was strongly associated with obesity (OR: 7.8, 95% CI: 5.3-11.3), diabetes (OR 3.6, 95% CI: 2.3-5.7), and hypertension (OR 3.2, 95% CI: 2.6-4.0). Among the quantitative measures, most affected were total cholesterol (+0.81 standard deviations, 95% CI 0.73-0.88), LDL cholesterol (+0.89, 95% CI: 0.79-0.99), and t-PA (+0.56, 95% CI: 0.48-0.63). Triglycerides and HDL cholesterol profiles were similarly poor in both urban and rural environments, but significantly worse among rural participants after BMI-adjustment. For most of the risk factors, the strength of the association with urban residence did not vary with sex. Obesity was a major exception, with urban women at particularly high risk (26% age-standardized prevalence) compared to urban men (7%). Overall, urban residents had substantially worse cardiovascular risk profiles, with some risk factors at levels typically seen in the developed world.
authors.affiliation: Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States of America.|Vanderbilt Genetics Institute, Vanderbilt University Medical School, Nashville, Tennessee, United States of America.
authors.forename: Nuri
authors.initials: N
authors.lastname: Kodaman
authors.affiliation: Department of Thoracic Surgery and Division of Epidemiology, Vanderbilt University Medical School, Nashville, Tennessee, United States of America.
authors.forename: Melinda C
authors.initials: MC
authors.lastname: Aldrich
authors.affiliation: Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States of America.|Vanderbilt Genetics Institute, Vanderbilt University Medical School, Nashville, Tennessee, United States of America.
authors.forename: Rafal
authors.initials: R
authors.lastname: Sobota
authors.affiliation: Department of Cardiology, Division Heart & Lungs, UMC Utrecht, Utrecht, the Netherlands.|Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, the Netherlands.|Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom.
authors.forename: Folkert W
authors.initials: FW
authors.lastname: Asselbergs
authors.affiliation: University of Ghana, Legon, Ghana.
authors.forename: Kwabena A
authors.initials: KA
authors.lastname: Poku
authors.affiliation: Department of Medicine, Vanderbilt University Medical School, Nashville, Tennessee, United States of America.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Brown
authors.affiliation: Department of Biostatistics and Epidemiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Moore
authors.affiliation: Department of Genetics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States of America.|Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, United States of America.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking; D011795:Surveys and Questionnaires; D010959:Tissue Plasminogen Activator / Q000097:blood; D014280:Triglycerides / Q000097:blood; D014507:Urbanization; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D017395:Plasminogen Activator Inhibitor 1; D014280:Triglycerides; D002784:Cholesterol; D010959:Tissue Plasminogen Activator