Cardiovascular screening in Africa: the importance of early vascular assessment in high-risk patients
A silent rise of cardiovascular diseases in Sub-Saharan Africa
Cardiovascular diseases are now the leading cause of death worldwide, accounting for approximately 19.8 million deaths each year according to the World Health Organization (1). More than three-quarters of these deaths occur in low- and middle-income countries (1).
In sub-Saharan Africa, the epidemiological transition associated with urbanization, sedentary lifestyles, obesity, and the rising prevalence of diabetes is contributing to a rapid increase in non-communicable diseases (2,3).
Hypertension remains one of the leading cardiovascular risk factors across the African continent, with screening, treatment, and blood pressure control rates still largely insufficient (2). This situation frequently leads to late diagnoses, often made only once complications have already occurred.
Dr. Abdou Latif Mousse, a Beninese cardiologist actively involved in cardiovascular prevention, emphasizes that this issue has become a major public health challenge in Benin.
Cardiovascular diseases are still diagnosed too late
Despite public awareness campaigns and national prevention programs, many patients are still diagnosed at advanced stages of disease, sometimes only after severe complications develop.
According to Dr. Mousse:
“Most patients who come in are not even aware that they are hypertensive and are only diagnosed once complications appear.”
In hospital practice, the consequences of delayed diagnosis are particularly visible in nephrology and neurology departments.
Hypertension and diabetes account for a significant proportion of chronic kidney disease and stroke cases hospitalized in Benin (2,4). This reflects the considerable burden of poorly controlled cardiovascular risk factors within the general population.
Beyond the initial diagnosis, insufficient long-term follow-up and limited public awareness also contribute to the silent progression of vascular disease (2,3).
Cardiovascular prevention begins during the first 1000 days
For Dr. Mousse, cardiovascular prevention should not begin only in adulthood. Early-life determinants play a major role in future cardiovascular risk.
Studies on the developmental origins of chronic diseases have shown that exposure to maternal malnutrition, stress, gestational diabetes, or hypertension during pregnancy can have long-term effects on cardiovascular and metabolic development in children (5,6).
“Future cardiovascular health is closely linked to what the child experienced during the first 1000 days.”
The first 1000 days, from conception through the first two years of life, therefore represent a critical period for cardiovascular programming (5).
This perspective highlights the importance of integrating nutrition, maternal follow-up, metabolic prevention, and environmental factors into broader cardiovascular prevention strategies (5,6).
Why arterial assessment should be part of cardiovascular screening
In patients with hypertension, diabetes, chronic kidney disease, or obesity, vascular assessment remains insufficiently integrated into routine clinical practice.
However, peripheral arterial lesions may remain silent for years, even in patients with few symptoms or only moderate risk factors (7).
Dr. Mousse stresses the importance of going beyond simple pulse palpation:
“If we do not assess, we do not know.”
The Ankle-Brachial Index (ABI) is now recognized as a simple, non-invasive, and guideline-recommended tool for screening lower-extremity peripheral arterial disease (7). It enables early identification of vascular involvement associated with increased cardiovascular risk (7,8).
This approach is particularly relevant in diabetic and hypertensive patients, in whom vascular disease may progress asymptomatically for long periods of time (7,8).
Toward more structured and accessible cardiovascular screening
Improving cardiovascular screening also requires better access to diagnostic tools and a more efficient organization of patient care pathways.
Dr. Mousse particularly highlights the value of tools that enable rapid and standardized assessment of high-risk patients, both for screening and long-term follow-up.
In some young patients presenting with wounds or advanced vascular complications, early arterial assessment may help prevent major amputations and their long-term functional and social consequences (8).
“These are not necessarily 70-year-old patients. Sometimes they are 40-year-old patients undergoing amputations.”
Beyond clinical evaluation itself, building networks of healthcare professionals trained in vascular screening appears essential to improve the management of patients at high cardiovascular risk (2,7).
Combining electrocardiography and vascular assessment to identify high-risk patients
Comprehensive cardiovascular evaluation should not rely solely on the detection of hypertension or diabetes.
Combining simple complementary examinations, such as electrocardiography and ABI measurement, may improve the identification of high-risk cardiovascular patients (7,8).
Dr. Mousse also highlights the value of digital tools that facilitate rapid testing, data sharing, continuity of care, and remote clinical decision-making.
In settings where access to specialists may be limited, digitalization of medical data can help accelerate referrals and improve care coordination (9).
Key message for clinicians
In sub-Saharan Africa, cardiovascular diseases remain largely underdiagnosed and are often identified only at advanced stages (2,3).
Early screening of cardiovascular risk factors - particularly hypertension, diabetes, and peripheral arterial disease - represents a major opportunity to reduce severe complications such as stroke, chronic kidney disease, and amputations (2,4,7).
Systematically integrating vascular assessment into the management pathway of high-risk patients is an essential step toward more comprehensive, earlier, and better-structured cardiovascular prevention.
Key takeaways
Cardiovascular diseases are rapidly increasing in sub-Saharan Africa, with diagnosis still frequently delayed (1,2).
Hypertension and diabetes are major contributors to stroke and chronic kidney disease (2,4).
Peripheral vascular disease may progress silently in high-risk patients (7).
The Ankle-Brachial Index (ABI) enables simple and early detection of peripheral arterial disease (7).
Combining prevention, vascular assessment, and digitalized care pathways may improve cardiovascular management outcomes (7,9).
