Cardiometabolic disease risk factors in pre- and postmenopausal women from four sub-Saharan African countries: A cross-sectional study

Raylton P Chikwati; Nasrin Goolam Mahyoodeen; Nicole G Jaff; Michele Ramsay; Lisa K Micklesfield; Alisha N Wade; Godfred Agongo; Gershim Asiki; Solomon S R Choma; Palwende R Boua; Jaya A George; Nigel J Crowther

doi:10.1016/j.maturitas.2023.04.005

Cardiometabolic disease risk factors in pre- and postmenopausal women from four sub-Saharan African countries: A cross-sectional study

Maturitas. 2023 Jun:172:60-68. doi: 10.1016/j.maturitas.2023.04.005. Epub 2023 Apr 20.

Authors

Affiliations

¹ Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: rayltonc@gmail.com.
² Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³ Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴ Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵ South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁶ MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷ Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana; Department of Biochemistry and Forensic Science, School of Chemical and Biochemical Sciences, C. K. Tedam University of Technology and Applied Science, Navrongo, Ghana.
⁸ African Population and Health Research Center, Nairobi, Kenya.
⁹ Department of Pathology and Medical Sciences, DIMAMO HDSS, University of Limpopo, Polokwane, South Africa.
¹⁰ Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Burkina Faso.
¹¹ Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Chemical Pathology, National Health Laboratory Service, Johannesburg, South Africa.

Abstract

Objective: To compare the risk factors for cardiometabolic disease between pre- and postmenopausal women from four sub-Saharan African countries.

Study design: This cross-sectional study included 3609 women (1740 premenopausal and 1869 postmenopausal) from sites in Ghana (Navrongo), Burkina Faso (Nanoro), Kenya (Nairobi), and South Africa (Soweto and Dikgale). Demographic, anthropometric and cardiometabolic variables were compared between pre- and postmenopausal women, within and across sites using multivariable regression analyses. The sites represent populations at different stages of the health transition, with those in Ghana and Burkina Faso being rural, whilst those in Kenya and South Africa are more urbanised.

Main outcome measures: Anthropometric and cardiometabolic variables.

Results: The prevalence rates of risk factors for cardiometabolic disease were higher in South (Soweto and Dikgale) and East (Nairobi) Africa than in West Africa (Nanoro and Navrongo), irrespective of menopausal status. Regression models in combined West African populations demonstrated that postmenopausal women had a larger waist circumference (β = 1.28 (95 % CI: 0.58; 1.98) cm), log subcutaneous fat (β =0.15 (0.10; 0.19)), diastolic (β = 3.04 (1.47; 4.62) mm Hg) and log systolic (β = 0.04 (0.02; 0.06)) blood pressure, log carotid intima media thickness (β = 0.03 (0.01; 0.06)), low-density lipoprotein cholesterol (β = 0.14 (0.04; 0.23) mmol/L) and log triglyceride (β= 0.10 (0.04; 0.16)) levels than premenopausal women. No such differences were observed in the South and East African women.

Conclusions: Menopause-related differences in risk factors for cardiometabolic disease were prominent in West but not East or South African study sites. These novel findings should inform cardiometabolic disease prevention strategies in midlife women specific to rural and urban and peri-urban locations in sub-Saharan Africa.

Keywords: AWI-Gen; Cardiometabolic disease risk; Postmenopause; Premenopause; Sub-Saharan Africa.

MeSH terms

Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Carotid Intima-Media Thickness
Cross-Sectional Studies
Female
Humans
Kenya
Postmenopause*
Risk Factors
South Africa / epidemiology

Grants and funding

U54 HG006938/HG/NHGRI NIH HHS/United States