High prevalence of peripheral atherosclerosis in a rapidly developing country

doi:10.1016/S0021-9150(00)00376-2

Atherosclerosis

Volume 153, Issue 1, November 2000, Pages 9-21

https://doi.org/10.1016/S0021-9150(00)00376-2 Get rights and content

Abstract

Cardiovascular disease is rapidly increasing in developing countries experiencing epidemiological transition. We investigated the prevalence of peripheral atherosclerosis in a rapidly developing country and compared our findings with data previously reported in Western populations. A cardiovascular risk factor survey was conducted in 1067 individuals aged 25–64 randomly selected from the general population of Seychelles. High-resolution ultrasonography of the right and left carotid and femoral arteries was performed in a random subgroup of 503 subjects (245 men and 258 women). In each of the four arteries, arterial wall thickness (in plaque-free segments) and atherosclerotic plaques (i.e. focal wall thickening at least 1.0 mm thick) were measured separately. The prevalence of peripheral atherosclerosis was high in this population. For instance, at least one plaque ≥1.0 mm was found in, respectively, 34.9 and 27.5% of men and women aged 25–34 and at least one plaque ≥2.5 mm was found in, respectively, 58.2 and 36.9% of men and women aged 55–64. With reference to data found in the literature, the prevalence of carotid atherosclerosis appeared to be significantly higher in Seychelles than in Western populations. This study provides further evidence for the importance of cardiovascular disease in developing countries. Determinants should be identified and relevant prevention and control programs implemented.

Introduction

Accumulating data support the view of an emerging epidemic of cardiovascular disease (CVD) in developing countries [1], [2]. Increasing CVD in developing countries relate, among other factors, to ageing populations, changing lifestyles accompanying industrialisation and urbanisation and nutrition transition [1], [3].

As developing countries will certainly not be able to afford the high costs of CVD treatments for large portions of their populations, appropriate preventive strategies should be promptly implemented after specific determinants of CVD epidemic in these countries have been identified [4], [5].

In Seychelles, a survey conducted in 1989 demonstrated high levels of several cardiovascular risk factors (CVRF) in the general population [6], [7], [8], [9]. Subsequently, a national program for the prevention and control of CVD was designed and implemented [10], [11]. In 1994, a second independent population-based survey (‘Seychelles Heart Study II’) was conducted to assess trends in CVRF levels in the population. The survey also included high-resolution ultrasonography of the carotid and femoral arteries. This new non-invasive technique permits precise quantification of atherosclerotic changes in peripheral arteries and is now frequently used in observational studies or clinical trials on atherosclerosis [12]. Although many reports based on these measurements have been published, especially with regard to their relation with CVRF [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], data from non-selected populations are sparse and no such data have been collected systematically in populations from developing countries so far.

The aim of this study was therefore to determine the prevalence of persons with peripheral atherosclerosis in the general population of Seychelles and to subsequently compare these findings with data previously reported in Western populations.

Section snippets

General population

The Republic of Seychelles consists of 115 islands lying in the Indian Ocean, 1800 km east of Kenya and 1800 km north of Mauritius. The islands were first inhabited when French colonials settled in Seychelles in 1770, joined over the next decades by larger number of African slaves and indentured labourers (coming mainly from East and Central Africa and Madagascar) and, later, by small numbers of Indian and Chinese immigrants [29]. Eighty-nine percent of the total population lives on the largest

Study group characteristics

Table 2 displays characteristics of the subjects selected for ultrasonography. The distribution of age and black phenotype was similar in both genders. Men had higher prevalence of smoking (≥1 cigarette every day), higher systolic and diastolic BP and higher triglycerides concentration. Women had higher BMI and marginally higher total cholesterol concentration. The distribution of these characteristics was not statistically different between the 503 participants selected for ultrasonography and

Discussion

This study aimed at quantifying peripheral atherosclerosis in the general population of a developing country. We used high-resolution ultrasonography and measured arterial wall thickness (IMT) and atherosclerotic plaque prevalence in carotid and femoral arteries. The study included fairly large numbers of subjects of both genders and several age categories, and participation rate was high.

Acknowledgements

The authors wish to thank L. Chow, G. Madeleine, A. Rwebogora, M. Abel, D. Larue and J. Brioche (Ministry of Health, Seychelles) for their very valuable assistance in the study; Professor R. Darioli, Professor A. Pecoud, Dr M. Depairon and Dr J.P. Gervasoni (University of Lausanne); the Government of Seychelles (particularly Health Ministers J. Dugasse and predecessor R. Adam) for their support; and all the participants in the survey for their kind cooperation. The authors also thank the

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Estimation of the epidemiological burden of carotid atherosclerosis can serve as a basis for prevention and management of cardiovascular disease. We aimed to provide the first estimation on the prevalence, number of cases, and risk factors for carotid atherosclerosis in the general population globally and regionally.
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We identified 8632 articles through our database search, of which 515 were eligible for full-text review, including 37 articles from our previous study, and 59 articles were eligible for inclusion in our systematic review and meta-analysis. Overall, in people aged 30–79 years in 2020, the global prevalence of increased carotid intima-media thickness is estimated to be 27·6% (95% CI 16·9–41·3), equivalent to 1066·70 million affected people and a percentage change of 57·46% from 2000; of carotid plaque is estimated to be 21·1% (13·2–31·5), equivalent to 815·76 million affected people and a percentage change of 58·97% from 2000; and carotid stenosis is estimated to be 1·5% (1·1–2·1), equivalent to 57·79 million affected people and a percentage change of 59·13% from 2000. The prevalence of increased carotid intima-media thickness, carotid plaque, and carotid stenosis increased consistently with age and was higher in men than in women. Current smoking, diabetes, and hypertension were common risk factors for increased carotid intima-media thickness and carotid plaque. In 2015, the Western Pacific region had the largest share of global cases of increased carotid intima-media thickness (317·62 million [33·36%] of 952·13 million affected people) and carotid plaque (240·77 million [33·20%] of 725·25 million), whereas the African region had the smallest share of cases of increased carotid intima-media thickness (59·08 million [6·21%]) and the Eastern Mediterranean region had the smallest share of carotid plaque cases (44·59 million [6·15%]).
A substantial global burden of carotid atherosclerosis exists. Effective strategies are needed for primary prevention and management of carotid atherosclerosis. High-quality epidemiological investigations on carotid atherosclerosis are needed to better address the global burden of carotid atherosclerosis at finer levels.
None.
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It is a chronic, progressive, multifocal arterial wall disease caused by local and systemic inflammation, responsible for major cardiovascular complications such as myocardial infarction and stroke. Atherosclerosis is one of the major cause of illness and death in industrialized nations and is rapidly increasing in developing nations [1,2]. Atherosclerosis is linked to a variety of risk factors including high LDL cholesterol and triglyceride levels, diabetes, smoking, hypertension, sedentary lifestyle, and upregulated inflammatory mediators.
Cardiovascular diseases as atherosclerosis are associated to an inflammatory state of the vessel wall which is accompanied by endothelial dysfunction, and adherence and activation of circulating inflammatory cells. Hydrogen sulfide, a novel cardiovascular protective gaseous mediator, has been reported to exert anti-inflammatory activity. We have recently demonstrated that the SH containing ACE inhibitor zofenoprilat, the active metabolite of zofenopril, controls the angiogenic features of vascular endothelium through H₂S enzymatic production by cystathionine gamma lyase (CSE). Based on H₂S donor/generator property of zofenoprilat, the objective of this study was to evaluate whether zofenoprilat exerts anti-inflammatory activity in vascular cells through its ability to increase H₂S availability.
Here we found that zofenoprilat, in a CSE/H₂S-mediated manner, abolished all the inflammatory features induced by interlukin-1beta (IL-1β) in human umbilical vein endothelial cells (HUVEC), especially the NF-κB/cyclooxygenase-2 (COX-2)/prostanoid biochemical pathway. The pre-incubation with zofenoprilat/CSE dependent H₂S prevented IL-1β induced paracellular hyperpermeability through the control of expression and localization of cell-cell junctional markers ZO-1 and VE-cadherin. Moreover, zofenoprilat/CSE dependent H₂S reduced the expression of the endothelial markers CD40 and CD31, involved in the recruitment of circulating mononuclear cells and platelets. Interestingly, this anti-inflammatory activity was also confirmed in vascular smooth muscle cells and fibroblasts as zofenoprilat reduced, in both cell lines, proliferation, migration and COX-2 expression induced by IL-1β, but independently from the SH moiety and H₂S availability.
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Objectives: A relatively high proportion of Iranian patients with coronary artery disease (CAD) have normal levels of traditional lipid risk factors and show early onset of CAD. In this study we examined the roles of apolipoprotein B (apoB), apolipoprotein AI (apoAI) and lipoprotein (a) [LP(a)] in predicting coronary heart disease in normolipidemic patients and those with premature CAD (age ≤50).
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Results: ApoB concentrations were significantly higher in patients with CAD (CAD+) relative to patients without CAD (CAD−) in the two subgroups. Multiple logistic regression after controlling for age and others risk factors showed apoB as the best determinant of CAD in the normolipidemic subgroup (OR, 4.3, p < 0.001) and in the men aged ≤50 (OR, 5.7, p < 0.001). ApoB was the best predictor of CAD in a subgroup of very young patients (age ≤40, n = 77, OR, 8.6, p < 0.009). There was a significant correlation between severity of atherosclerosis and serum apoB concentration in the normolipidemic subgroup (r = 0.22, p < 0.008).
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High prevalence of peripheral atherosclerosis in a rapidly developing country

Abstract

Introduction

Section snippets

General population

Study group characteristics

Discussion

Acknowledgements

Lancet

Atherosclerosis

Ultrasound Med. Biol.

Atherosclerosis

Lancet

Emerging epidemic of cardiovascular disease in developing countries

Circulation

The epidemiological transition. A theory of the epidemiology of population change

Milbank Memorial Fund Q.

The global impact of noncommunicable diseases: estimates and projections

World Health Stat. Q.

Non-transmissible diseases in the world: a health priority problem of increasing importance

World Health Stat. Q.

The Seychelles cardiovascular diseases survey 1989 (Methods)

Soz.- Praventivmed.

The Seychelles cardiovascular diseases survey 1989 (Results)

Soz.- Praventivmed.

High prevalence of cardiovascular risk factors in the Seychelles (Indian Ocean)

Arterioscler. Thromb.

The epidemiologic transition to chronic diseases in developing countries: cardiovascular mortality, morbidity, and risk factors in Seychelles (Indian Ocean). Investigators of the Seychelles Heart Study

Soz.- Praventivmed.

Guidelines for a collaborative long term program of reduction of cardiovascular risk factors in the population of the Seychelles

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The cardiovascular disease situation in Seychelles

World Health Stat. Q.

Risk factors for early carotid atherosclerosis in middle-aged French women

Arterioscler. Thromb.

Noninvasively diagnosed peripheral arterial disease as a predictor of mortality: results from a prospective study

Circulation

Effects of colestipol–niacin therapy on human femoral atherosclerosis

Circulation

Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case-control study

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Ultrasonographically assessed carotid morphology and the risk of coronary heart disease

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Cardiovascular determinants of carotid artery disease. The Rotterdam elderly study

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Ultrasound B-mode imaging in observational studies of atherosclerotic progression

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Alcohol consumption and ultrasonographically assessed carotid artery wall thickness and distensibility. The atherosclerosis risk in communities (ARIC) study investigators

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The relation of lipoprotein[a] concentrations and apolipoprotein[a] phenotypes with asymptomatic atherosclerosis in subjects of the atherosclerosis risk in communities (ARIC) study

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Unpublished Documents on the History of the Seychelles Anterior to 1810

The Seychelles Heart Study II: methods and selected basic findings

Seychelles Med. Dental J.

Prevalence of diabetes and obesity in the adult population of the Seychelles

Diabetic Med.