Introduction:
The African immigrant population grew 40-fold between 1960 and 2007, from 35,355 to 1.4 million with one third coming from West Africa, primarily Ghana and Nigeria. African immigrants have been understudied and, traditionally, lumped into the racial category of Black/African-American. We have examined the prevalence of CVD risk factors (hypertension, overweight/obesity, diabetes, hyperlipidemia, current smoking and physical inactivity), assessed global CVD risk and identified independent predictors of increased CVD risk by sex in West African immigrants (WAI).
Methods:
Cross-sectional study of WAI (Ghanaians and Nigerians) aged 35-74 years recruited from churches in the Baltimore/ Washington, DC metropolitan area. CVD risk factors were determined per AHA guidelines. Descriptive statistics were performed on participant’s Pooled Cohort Equations (PCE) scores and CVD risk factors with comparison by sex. Participants with PCE scores ≥7.5% and ≥3 CVD risk factors were deemed high risk. A multivariable logistic regression was fitted to identify independent predictors of high CVD risk.
Results:
The mean age of the 253 participants was 49.5±9.2 years and 58% were female. Males were more likely to be employed than females (90% vs. 72%; p=0.001). Only 52% of participants had health insurance. The majority [54% [137/253)] had ≥3 CVD risk factors and 28% had PCE score ≥7.5%. Smoking was the least prevalent (<1%) and overweight/obesity the most prevalent (88%) risk factor. Although females (64%) were more likely to be treated for hypertension than males (36%), there was no difference in hypertension control by sex. Diabetes was identified in 16% of the participants. Mean total cholesterol (TC) was 180.9±33.9mg/dL and 32% had TC level ≥200mg/dL. In addition, 44% were found to be physically inactive (<150minutes/week of moderate or <75minutes/week of vigorous physical activity). In females, employment [0.18 AOR, 95%CI: 0.075-0.44)] and health insurance [0.35 AOR, 95%CI 0.14-0.87)] were associated with a PCE score ≥7.5%. In males, higher social support was associated with a 0.92 (95%CI: 0.84-0.98) odds of having ≥3 CVD risk factors.
Conclusion:
The high prevalence of CVD risk among relatively young WAIs is worrisome and suggests that the “healthy immigrant effect” may no longer hold for 21st century African immigrants. Employment and health insurance were protective against high CVD risk in females with social support protective against high CVD risk in males. CVD prevention strategies must be tailored to the unique needs of the WAI with consideration of socioeconomic status and sex.
Sex Differences in Cardiovascular Disease Risk of Ghanaian‐ and Nigerian‐Born West African Immigrants in the United States: The Afro‐Cardiac Study