Markers of Atherosclerosis, Clinical Characteristics, and Treatment Patterns Among Middle-Aged Adult Patients with Heart Failure in Kenya

Abstract

Background— While risk factors for heart failure are increasingly common worldwide, the contribution of markers of atherosclerosis to heart failure in sub-Saharan Africa is largely unknown. Objectives— To assess 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 assess the risk factors for heart failure 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 describe the relation of wall motion abnormalities on echocardiogram, ABI <0.9 and ischemic pattern on ECG to 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 (standard deviation 13) years. Most patients had hypertension (53%), and 16% had HIV. Lipids were in the normal range for all. Cases were older than controls (62 vs. 58 years, respectively). The most common abnormality associated with heart failure was dilated cardiomyopathy. Ischemic heart failure was the second most common in men. Cases were more likely to have an ABI <0.9 (46% vs. 31%, AOR 1.99, 95% CI 1.19–3.32), ischemia/infarct on ECG (68% vs. 43%, AOR 3.01, 95% CI 1.43–6.34), and wall motion abnormalities on echocardiogram (54% vs. 15%, AOR 7.00, 95% CI 3.95–12.39). Conclusion— Ischemic heart failure is more common in Kenya than previously recognized. Non- invasive markers of atherosclerosis are routinely found among heart failure patients. Treatment and prevention of heart failure in sub-Saharan Africa must consider a wide range of causes including those related to atherosclerosis