Faculty of Health Sciences
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Item Carotid Atherosclerosis, Microalbuminuria, and Estimated 10-Year Atherosclerotic Cardiovascular Disease Risk in Sub-Saharan Africa(2022-04-01) Engelbert A Nonterah; Daniel Boateng; Nigel J Crowther; Kerstin Klipstein-Grobusch; Abraham R Oduro; Godfred Agongo; Shukri F Mohamed; Palwendé R Boua; Solomon S R Choma; Shane A Norris; Stephen M Tollman; Michiel L Bots; Michèle Ramsay; Diederick GrobbeeImportance: Carotid atherosclerosis and microalbuminuria are associated with atherosclerotic cardiovascular disease (ASCVD) but are understudied in sub-Saharan Africa. Objective: To evaluate the association of carotid atherosclerosis and microalbuminuria with 10-year ASCVD risk in middle-aged sub-Saharan African individuals. Design, setting, and participants: This cross-sectional study conducted analyses of baseline data from the African-Wits-INDEPTH (International Network for the Demographic Evaluation of Populations and Their Health in Low- and Middle-Income Countries) genomic study (AWI-Gen). Women and men aged 40 to 60 years without baseline CVD and drawn from Burkina Faso, Ghana, Kenya, and South Africa were included. Main outcomes and measures: Hypotheses for the analyses were formulated after data collection. The main exposures were carotid atherosclerosis, assessed using carotid intima-media thickness (CIMT) using B-mode ultrasonography, and microalbuminuria, measured using spot urine albumin (SUA) and urine albumin-creatinine ratio (uACR). The main outcome was high ASCVD risk, defined as a 2018 Pooled Cohort Equations score of 7.5% or greater. Associations were estimated using adjusted multivariable logistic regression analyses. Findings: A total of 9010 participants with a mean (SD) age of 50 (6) years and 4533 (50.3%) women were included. High CIMT, SUA, and uACR were each associated with older age (eg, mean [SD] age of participants with high vs reference range CIMT: 55 [5] years vs 50 [6] years; P < .001) and high prevalence of both diabetes and hypertension (eg, hypertension among those with high vs reference range SUA: 213 of 1117 [19.1%] vs 356 of 2549 [14.0%]; P < .001). Smokers were likely to have higher vs reference range SUA (210 [18.8%] vs 407 [16.0%]) and uACR (138 of 707 [19.5%] vs 456 of 2797 [16.3%]). Carotid atherosclerosis was common in Burkina Faso (82 of 262 [31.3%]) and Ghana (91 [34.7%]), while microalbuminuria, measured by SUA, was common in Kenya (272 [24.4%]) and South Africa (519 [46.5%]). SUA was associated with higher odds of carotid atherosclerosis (odds ratio [OR], 1.77; 95% CI, 1.04-3.01) compared with uACR (OR, 0.51; 95% CI, 0.27-0.95). Common CIMT, SUA, and uACR were associated with 10-year ASCVD risk, with CIMT having a stronger association with 10-year ASCVD risk in both women (OR, 1.95; 95% CI, 1.78-2.14) and men (OR, 1.73; 95% CI, 1.55-1.93) than SUA (women: OR, 1.29; 95% CI, 1.12-1.43; men: OR, 1.46; 95% CI, 1.26-1.55) and uACR (women: OR, 1.32; 95% CI, 1.10-1.54; men: OR, 1.35; 95% CI, 1.15-1.46). Conclusions and relevance: The presence of microalbuminuria measured by SUA may indicate risk of subclinical carotid atherosclerosis and high 10-year ASCVD risk in middle-aged residents of sub-Saharan Africa. These data should be confirmed in longitudinal studies of cardiovascular events.Item Middle cerebral arterial flow redistribution is an indicator for intrauterine fetal compromise in late pregnancy in lowresource settings A prospective cohort studyS Ali; M. G Kawooya; J Byamugisha; I. M Kakibogo; Kerstin Klipstein-Grobusch; E et alItem Maternal and neonatal outcomes following the introduction of oral hypoglycaemic agents for gestational diabetes mellitus were comparable to insulin monotherapy in two historical cohortsVeronique Nicolaou; Larske Soepnel; Kenneth Huddle; N Levitt; Kerstin Klipstein-Grobusch; Shane NorrisItem Scaleup integrated care for diabetes and hypertension in Cambodia Slovenia and Belgium SCUBY a study design for a quasiexperimental multiple case studyJ van Olmen; S Menon; AP Susic; Kerstin Klipstein-Grobusch; E Wouters; E et alItem Completeness of obstetric referral lettersnotes from subdistrict to district level in three rural districts in Greater Acraa region of Ghana an implementation research using mixed methodsM Amoakoh-Coleman; E Ansah; Kerstin Klipstein-Grobusch; D ArhinfulItem Microvascular and macrovascular complications in type 2 diabetes Ghanaian residents in Ghana and Europe The Rodam studyC Hayfron-Benjamin; B Van den Born; M Van der Zee; A Amoah; Kerstin Klipstein-Grobusch; E et alItem Using Mobile Health to Support Clinical DecisionMaking to Improve Maternal and Neonatal Health Outcomes in Ghana Insights of Frontline Health Worker Information NeedsH Amoakoh; Kerstin Klipstein-Grobusch; D Grobbee; M Amoakoh-Coleman; E Oduro-Mensah; E et alItem The association between HIV infection and pulmonary function in a rural African populationM Varkila; Alinda Vos; R Barth; H Tempelman; W Deville; E et al; Kerstin Klipstein-GrobuschItem Is social support associated with hypertension control among Ghanaian migrants in Europe and nonmigrants in Ghana The RODAM studyG Nyaaba; K Stronks; K Meeks; E Beune; Kerstin Klipstein-Grobusch; E et alItem Determinants of coronary artery disease risk factor management across three world regionsM Zhao; I Graham; M Cooney; D Grobbee; I Vaartjes; Kerstin Klipstein-Grobusch