Introduction:
There are research gaps on cardiovascular disease (CVD) risk of the burgeoning West-African immigrants (WAI) in the United States (US) because they are lumped into the racial category of “Black/African-American”. The epidemiological transition in Africa suggests that WAI may be at high risk for CVD prior to migration, which may worsen with increased years of US residence. We sought to examine the global CVD risk using the 10-year Framingham CVD score (FRS10), CVD risk factors and identify independent predictors of increased CVD risk, among WAI.
Methods:
The “AFRO-CardiAC” study is a community-based cross-sectional study among first generation WAI aged 35-74 years, born in Ghana/Nigeria and residing in the Washington, D.C metropolis. Cardiovascular disease risk factors (total cholesterol, HDL cholesterol, hypertension (HTN), diabetes, smoking and body mass index) and health behaviors were determined according to AHA guidelines. Descriptive statistics were performed on participant’s FRS10 and CVD risk factors with comparison by sex. Participants with FRS10 below 10% were deemed low risk and those at ≥ 10% were classified as high risk. A multivariate logistic regression was fitted to identify independent risk factors associated with high CVD risk.
Results:
A total of 145 participants have been recruited to date; aged 50±8.5years and 61% female. The majority (72%; 104/145) have resided in the US for more than 10 years. The overall prevalence of HTN was 53% with no significant difference between males (46%) and females (57%)[p=0.201]. The prevalence of overweight/obesity was 94% in females and 82% in males (p<0.0001). Only one participant reported smoking and 15% were diabetic, with no sex differences (males 20 % and females 12 %). Males had a significantly higher mean FRS10 (11.10±8.85) than females (6.66±6.48) [p=0.0016]. Also, 13%, 23%, 64% (n=56) of males were classified as having high, intermediate and low risk of CVD compared to 3%, 20%, and 77% of females (n=87)[p=0.082]. The predictors of high CVD risk using dichotomized FRS10 categories (<10% vs. ≥10%) as the outcome included increasing length of stay in the US, [Odds Ratio (OR):1.12, 95%CI: 1.04-1.20,p= 0.001], unemployment[OR:7.0, 95% CI: 1.69-29.79, p=0.008] and household income less than $25,000 (OR: 4.17, 95%CI:1.33-13.08,p=0.014)
Conclusion:
In conclusion, this preliminary analysis of an ongoing study shows a high prevalence of major CVD risk factors in relatively young WAI. Males had a significantly higher global CVD risk although females had a striking prevalence of overweight/obesity. Employment was protective against high CVD risk while lower income and longer stay in the US were associated with higher CVD risk. These data suggest a need for CVD prevention strategies that are tailored to the needs of the WAI with consideration of socioeconomic status and gender.
Sex Differences in Cardiovascular Disease Risk of Ghanaian‐ and Nigerian‐Born West African Immigrants in the United States: The Afro‐Cardiac Study