Cardiovascular Risk Factor Profiles and Disease in Black Compared to Other Africans with Chronic Kidney Disease
Date
2020-12-14
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background and Objectives. *e extent to which chronic kidney disease (CKD) impacts cardiovascular disease (CVD) in black
Africans is uncertain. We compared cardiovascular risk factors and CVD between black and other African CKD patients.
Methods. Cardiovascular risk factors, aortic and cardiac function, atherosclerosis extent, and cardiovascular event rates were
assessed in 115 consecutive predialysis (n = 67) and dialysis patients (n = 48) including 46 black and 69 other (32 Asian, 28 white,
and 9 mixed race) participants. Data were analysed in multivariable regression models. Results. Overall, black compared to other
African CKD patients had less frequent carotid artery plaque (OR (95% CI) = 0.38 (0.16–0.91)) despite an increased cardiovascular
risk factor burden. In receiver operator characteristic curve analysis, the Framingham score performed well in identifying nonblack
but not black CKD patients with carotid plaque (area under the curve (AUC) (95% CI) = 0.818 (0.714–0.921) and AUC (95%
CI) = 0.556 (0.375–0.921), respectively). Black compared to other African predialysis patients experienced larger Framingham
scores and more adverse nontraditional cardiovascular risk factors, impaired arterial and diastolic function but similar cardiovascular
event rates (OR (95% CI) = 0.93 (0.22 to 3.87)). Among dialysis patients, black compared to other Africans had an
overall similar traditional and nontraditional cardiovascular risk factor burden, similar arterial and diastolic function but increased
systolic function (partial R = 0.356, p = 0.01 and partial R = 0.315, p = 0.03 for ejection fraction and stroke volume,
respectively) and reduced cardiovascular event rates (OR (95% CI) = 0.22 (0.05 to 0.88)). Conclusion. Black compared to other
African CKD patients have less frequent very high risk atherosclerosis and experience weaker cardiovascular risk factor-atherosclerotic
CVD relationships. *ese disparities may be due to differences in epidemiological health transition stages. Among
dialysis patients, black compared to other Africans have less cardiovascular events, which may represent a selection bias as
previously documented in black Americans.