Ideal Cardiovascular Health Index and Its Determinants in a Rural South African Population

E J Ketelaar; A G Vos; N G Godijk; K Scheuermaier; W Devillé; H Tempelman; R A Coutinho; W D F Venter; D E Grobbee; K Klipstein-Grobusch

doi:10.5334/gh.801

Ideal Cardiovascular Health Index and Its Determinants in a Rural South African Population

Glob Heart. 2020 Nov 25;15(1):76. doi: 10.5334/gh.801.

Authors

E J Ketelaar¹, A G Vos^{1

2}, N G Godijk¹, K Scheuermaier^{1

3}, W Devillé^{1

4}, H Tempelman⁴, R A Coutinho¹, W D F Venter², D E Grobbee¹, K Klipstein-Grobusch^{1

5}

Affiliations

¹ Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, NL.
² Ezintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, ZA.
³ Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, ZA.
⁴ Ndlovu Care Group, Groblersdal, ZA.
⁵ Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, ZA.

PMID: 33299772
PMCID: PMC7693879
DOI: 10.5334/gh.801

Abstract

Background: The ideal cardiovascular health index (CVHI) is a measure to summarize cardiovascular (CV) health, and includes smoking, body-mass index, physical activity, blood pressure, glucose, total cholesterol, and diet.

Objective: This study aimed to assess CV health using the CVHI and determinants on CV health in a rural African population, and correlate carotid intima-media thickness (CIMT), a surrogate marker for atherosclerosis, with CVHI.

Methods: A cross-sectional analysis was performed on baseline data of the Ndlovu Cohort Study, located in rural South Africa. CVHI score (CVHIs) was calculated by the sum of favourable CVHI factors (range 0 to 7). Logistic regression was performed to examine the association of age, sex, HIV-status, education level, employment status, and income with good CV health (5-7 favourable health factors). Mean CIMT was displayed by poor, intermediate and good CV health.

Results: The study included 1927 participants with a mean age of 38.7 years (SD ± 12.8). Of the factors contributing to the CVHI, glucose and total cholesterol scored best; diet least good. Average CVHIs for the population was 4.4 (SD ± 1.2) and 53% of the population had a good CV health. Determinants associated with good CV health were younger age, higher educational attainment, and HIV positivity. CVHIs showed good agreement with CIMT.

Conclusion: CVHIs showed that more than half of the participants had a good CV health. Agreement between CVHIs and CIMT indicates potential use of CVHIs as a surrogate marker for CV risk. The study highlights the importance of education for health promotion; good CV health in HIV-positive participants may in part be attributed to more frequent health care contact and provision of chronic disease care.

Highlights: Good cardiovascular health (CVH) was observed in 53% of the study population.In global comparison, rural African study participants showed a good CVH score.HIV positivity was associated with a good CVH score.CVH score showed good agreement with carotid intima-media thickness.

Keywords: HIV; Ideal cardiovascular health index; South Africa; cardiovascular disease; carotid intima-media thickness; socio-economic status.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Body Mass Index
Cardiovascular Diseases / epidemiology*
Cardiovascular Diseases / physiopathology
Cross-Sectional Studies
Exercise / physiology*
Female
Follow-Up Studies
Health Status*
Humans
Male
Middle Aged
Prospective Studies
Risk Factors
Rural Population*
South Africa / epidemiology
Young Adult

Grants and funding

The Ndlovu Cohort study was supported by a grant from the Dutch AIDS Foundation; Dioraphte Foundation; De Grote Onderneming and the University Medical Center Utrecht.