Electrocardiographic Assessment of Coronary Artery Disease and Stroke Risk Factors in Rural and Urban Tanzania: A Case–control Study

• Published in: Journal of stroke and cerebrovascular diseases Vol. 23; no. 2; pp. 315 - 320
• Main Authors: Walker, Richard W., MD, Dewhurst, Matthew, MBBS, Gray, William K., PhD, Jusabani, Ahmed, M Med, Aris, Eric, MD, Unwin, Nigel, PhD, Swai, Mark, MD, Adams, Philip C., MA, Mugusi, Ferdinand, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2014; Saunders
• Subjects: African Continental Ancestry Group; Aged; Atrial Fibrillation - diagnosis; Atrial Fibrillation - ethnology; Atrial Flutter - diagnosis; Atrial Flutter - ethnology; Cardiovascular; Case-Control Studies; coronary artery disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - ethnology; Developing Countries; Electrocardiography; Female; Humans; Hypertrophy, Left Ventricular - diagnosis; Hypertrophy, Left Ventricular - ethnology; Incidence; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - ethnology; Neurology; Original; Predictive Value of Tests; Prevalence; Prognosis; Risk Assessment; Risk Factors; Rural Health; stroke; Stroke - diagnosis; Stroke - ethnology; sub-Saharan Africa; Tanzania; Tanzania - epidemiology; Urban Health; Tanzania; coronary artery disease; Electrocardiography; sub-Saharan Africa; stroke; Tanzania
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2013.03.002

Background Although the association between cerebrovascular and coronary artery disease (CAD) is well known in high-income countries, this association is not well documented in black Africans. Aims The aim of this study was to document electrocardiographic (ECG) evidence of CAD in stroke cases and controls and to identify other common ECG abnormalities related to known stroke risk factors in a community-based population of incident stroke cases in Tanzania, East Africa. Methods This was a case–control study. Incident stroke cases were identified by the Tanzanian Stroke Incidence Project. Age- and sex-matched controls were randomly selected from the background population. Electrocardiograms were manually analyzed using the Minnesota Coding System, looking for evidence of previous myocardial infarction (MI), atrial fibrillation (AF) or atrial flutter (AFl), and left ventricular hypertrophy (LVH). Results In Hai, there were 93 cases and 241 controls with codable electrocardiograms, and in Dar-es-Salaam, there were 39 cases and 72 controls with codable electrocardiograms. Comparing cases and controls, there was a higher prevalence of MI and AF or AFl (but not LVH) in cases compared with controls. Conclusions This is the first published study of ECG assessment of CAD and other stroke risk factors in an incident population of stroke cases in sub-Saharan Africa. It suggests that concomitant CAD in black African stroke cases is more common than previously suggested.