Sex Differences in Absolute Cardiovascular Risk Profiles Among Rural Midlife and Elderly Kenyans: Influence of Obesity,Physical Activity,Smoking,and Blood Pressure Control

Abstract

Background:

Cardiovascular disease (CVD) will be the leading cause of mortality in Africa by 2030. Yet, little is known about the key drivers of CVD risk in the region.

Objective:

To examine the risk factors associated with CVD risk in a sample of rural midlife and elderly Kenyans.

Methods:

Cross-sectional study design. Data were collected following established protocols and included physical activity (PA), body mass index (BMI), waist circumference, blood pressure (BP), and self-reported medical history. Absolute CVD risk scores [Framingham risk scores (FRS)] were computed using non-lab-based Framingham algorithm. Descriptive and inferential statistics were used to evaluate factors associated with CVD risk scores and related sex-specific differences.

Results:

The sample (N = 102; mean age 59.8 ± 7.3 years; 57.8% female) was on average highly active (median 8891 steps/day) with 61.8% hypertension prevalence. Females versus males had higher BMI (29.2 vs. 24.8 kg/m²; P < 0.001) and central adiposity (84.8 vs. 18.6%; P < 0.001). However, they had lower systolic BP (129.3 vs. 138.3 mmHg; P = 0.032) and didn’t smoke (0.0 vs. 11.6%; P = 0.012). Females also were 6.6 years younger (P < 0.001) and had fewer years of education (P < 0.001) and less PA (P = 0.046). Overall, 34.3% of the sample was at high risk of CVD (FRS ≥20%), but females had lower risk compared with males (median FRS 7.4 vs. 25.0%; P < 0.001). Higher CVD risk was associated with higher education (P < 0.001) and having adequate income (P = 0.048). When considering females separately, none of the sociodemographic characteristics or PA measures were associated with CVD risk, but for males, higher CVD risk was associated with higher education (P = 0.025) and lower PA (P = 0.009).

Conclusion:

Age, BMI, BP, and smoking partially explain sex differences in CVD risk burden. However, sex differences also exist with males being older with higher education—factors associated with higher CVD risk. More research is needed to examine factors associated with absolute CVD risk in females.