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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.

Publication ,  Journal Article
Bloomfield, GS; DeLong, AK; Akwanalo, CO; Hogan, JW; Carter, EJ; Aswa, DF; Binanay, C; Koech, M; Kimaiyo, S; Velazquez, EJ
Published in: Glob Heart
March 2016

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.

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Published In

Glob Heart

DOI

EISSN

2211-8179

Publication Date

March 2016

Volume

11

Issue

1

Start / End Page

97 / 107

Location

England

Related Subject Headings

  • Rural Population
  • Risk Factors
  • Practice Guidelines as Topic
  • Odds Ratio
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Logistic Models
  • Kenya
  • Hypertension
 

Citation

APA
Chicago
ICMJE
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Bloomfield, G. S., DeLong, A. K., Akwanalo, C. O., Hogan, J. W., Carter, E. J., Aswa, D. F., … Velazquez, E. J. (2016). 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. Glob Heart, 11(1), 97–107. https://doi.org/10.1016/j.gheart.2015.12.014
Bloomfield, Gerald S., Allison K. DeLong, Constantine O. Akwanalo, Joseph W. Hogan, E Jane Carter, Daniel F. Aswa, Cynthia Binanay, Myra Koech, Sylvester Kimaiyo, and Eric J. Velazquez. “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.Glob Heart 11, no. 1 (March 2016): 97–107. https://doi.org/10.1016/j.gheart.2015.12.014.
Bloomfield, Gerald S., et al. “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.Glob Heart, vol. 11, no. 1, Mar. 2016, pp. 97–107. Pubmed, doi:10.1016/j.gheart.2015.12.014.
Bloomfield GS, DeLong AK, Akwanalo CO, Hogan JW, Carter EJ, Aswa DF, Binanay C, Koech M, Kimaiyo S, Velazquez EJ. 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. Glob Heart. 2016 Mar;11(1):97–107.
Journal cover image

Published In

Glob Heart

DOI

EISSN

2211-8179

Publication Date

March 2016

Volume

11

Issue

1

Start / End Page

97 / 107

Location

England

Related Subject Headings

  • Rural Population
  • Risk Factors
  • Practice Guidelines as Topic
  • Odds Ratio
  • Myocardial Ischemia
  • Middle Aged
  • Male
  • Logistic Models
  • Kenya
  • Hypertension