Lifestyle and Cardiovascular Risk Factors: Urban Population versus Rural Population in Sub-Saharan Africa

*Emmanuel Limbole Bakilo, Dadi-Serge Nkarnkwin, Lucette Womba, Venance Atheno, Mireille Kika, Jean Booto, Reagan Wiyaka, Martine Ekeba and Gilot Ngoma*

### **Abstract**

Cardiovascular diseases (CVD) are a major public health problem in Sub-Saharan Africa (SSA), as in the rest of the world, with increasingly increasing morbidity and mortality. We are presenting here, not the results of an epidemiological study, but rather a reflection on the problem of CVD and their risk factors (RFs) in SSA, taking into account the differences in lifestyle between rural and urban areas, the objective being to highlight the differences in the epidemiological profile trends relating to CVDs and their RFs between these two environments on the basis of existing data, to indicate some characteristic features of lifestyle in these two environments and to draw lessons from this in terms of the prospects for combating this new epidemic in this part of the world. We have indicated in this presentation that the prevalence of CVDs as well as that of their RFs show increasing trends in SSA due to new lifestyles linked in particular to urbanization and its numerous economic and social corollaries. However, data on their geographical and sociological distribution, especially in rural and urban areas, are still incomplete. The first existing epidemiological surveys seem to indicate that they are more firmly established in urban areas than in rural areas, probably linked to the difference in lifestyles between these two areas. We concluded by mentioning that it is necessary for SSA states to take the option of launching vast epidemiological and clinical research programs tending to make basic epidemiological data available, taking into account the specific geographic and sociological characteristics of African society. This knowledge, documented in the form of scientific evidence, would make it possible to consider with relevance and effectiveness measures to combat this new epidemic in developing countries.

**Keywords:** lifestyle, cardiovascular risk factors, rural area, urban area, Sub-Saharan Africa

#### **1. Introduction**

Cardiovascular diseases (CVDs), one of the main components of noncommunicable diseases (NCDs), are the first leading cause of mortality worldwide: more people die annually from CVDs than from any other cause.

In 2012, an estimated 17.5 million people died from these diseases, representing 30% of all deaths worldwide. An estimated 7.5 million of these deaths are due to coronary heart disease and 6.7 million to stroke. Low- and middle-income countries are disproportionately affected, accounting for over 80% of CVD deaths. By 2030, nearly 23.6 million people will die from cardiovascular diseases, primarily heart disease and stroke. According to projections, these conditions will remain the leading cause of death in the world [1].

• peripheral arterial disease – disease of blood vessels supplying the arms and

*Lifestyle and Cardiovascular Risk Factors: Urban Population versus Rural Population…*

• rheumatic heart disease – damage to the heart muscle and heart valves from

• congenital heart disease – malformations of heart structure existing at birth;

• deep vein thrombosis and pulmonary embolism – blood clots in the leg veins,

CVDs are promoted by a number of factors called "risk factors" (RFs).The main CVRFs are: poor diet, lack of physical activity, smoking, and harmful use of alcohol. These RFs, related to lifestyle, are called behavioral RFs. They can be the cause of physiological disturbances such as high blood pressure, hyperglycemia, hyperlipid-

CVRFs are also classified into non-modifiable factors and modifiable factors. The unchangeable risk factors are age, sex, race, and inheritance. Modifiable factors correspond to behavioral and biological factors. The **Figure 1** shows the link

STEPS studies carried out on a continental African scale in the 1980s indicated

Cardiovascular diseases are become a major public health problem throughout

*Relationship between CVRFs and CVDs. Source: Wong ND., Black et Grdin JM., Preventive cardiology: a*

The summary of the results of these studies is presented in **Table 1**.

the African Region. The main CVDs are: high blood pressure, stroke,

rheumatic fever, caused by streptococcal bacteria;

*DOI: http://dx.doi.org/10.5772/intechopen.96881*

which can dislodge and move to the heart and lungs.

emia and obesity; they are called intermediate risk factors.

high prevalence of CVRFs and especially hypertension.

legs;

between CVRFs and CVDs.

**Figure 1.**

**165**

*practical approach, Chicago, Mc Graw Hill, 2005.*

During the 3rd high-level meeting on NCDs, it was reported that seven in 10 people (71%) worldwide die from these diseases, which mainly consist of cardiovascular disease, cancer, diabetes and lung chronic diseases, an average of 41 million people each year. These include 15 million people dying from NCDs between the ages of 30 and 69; over 85% of these "premature" deaths occur in low- and middle-income countries [2].

CVDs, as other NCDs, are favored by factors that are related to genetics, physiology and sociological environment, and are called risk factors (RFs) or specifically cardiovascular risk factors (CVRFs).

The main RF of CVDs or NCDs, are related to the sociological environment, particularly with our lifestyle or our everyday behavior and are thus called behavioral RFs; they are thus deeply influenced by the culture and customs of the environment. It is this link between the sociological environment and the RFs of CVDs or NCDs, which could determine the African disparities between the rural environment, guardian of traditional culture and the urban environment, strongly influenced by Western culture.

## **1.1 Objective of the presentation**

In this chapter, we want to present an overview on CVDs and their RFs in rural and urban areas in Sub-Saharan Africa (SSA), to indicate some characteristic features of lifestyle in these two environments and to draw conclusions from them in terms of prospects for combating this new epidemic in this part of the world.

#### **1.2 Methodology**

We conducted a literature review related to the topic of the chapter, based on the available documentation as well as on the international scientific literature accessible through the PUBMED search engine where, after entering the keywords, the most relevant publications were selected. The use of this documentation was carried out taking into account the general situation in the world, the specific situation of the ASS with comparative observation between rural and urban areas.
