Insights into and anatomical perspectives of atherosclerosis among black Kenyans

Abstract

The pattern and anatomical perspectives of atherosclerosis were studied among black Kenyans by analyzing data from hospitals, clinics, autopsy and schools; cadaver dissection; histomorphometry, immunohistochemistry, light and electron microscopy. It was found that atherosclerosis caused 8.5% of total and 43.2% of cardiovascular deaths, 17.1 % of lower limb amputations, 9.5 % of heart failure and 3.5 % of hypertensive kidney disease. Its pathognomonic features were evident in up to 50.2 % of cases, starting in childhood. Mean age ranged from 54.7 to 59.5 years with mixed gender in morbidity and male preponderance at death. 13- 22 % of cases occurred before the age of 40 years. Co-morbidities comprised hypertension, smoking, infection, diabetes mellitus and alcohol consumption. Anatomical risk factors, present in over 25 % of cases, comprised variant arterial branching and origin, short stems, hypoplasia, tortuosity, myocardial bridges, suboptimal bifurcation angles and area ratios. Disease precursors present in the normal arterial wall were non-muscle cells, heterogeneity of smooth muscle cells and presence of vasa vasora in the tunica media; mutli-cellularity and microvascularization of tunica adventitia; and age related endothelial discontinuity and degeneration of tunica media. These findings suggest that atherosclerosis related diseases are not uncommon among Kenyans, affect a young predominantly male population; are predisposed by the conventional modifiable risk factors, infections and anatomical factors; and have precursors in normal arterial walls. Continuous preventive initiatives should be universal.