Sex-and-gender differences in cardiovascular risk factors and their correlates among adults in Freetown, Sierra Leone: A population-based health-screening survey

Objectives to evaluate the association of sex-and-gender-specific cardiovascular disease risk factors, their prevalence, and correlates among adults in Sierra Leone. Study design This community-based cross-sectional study used a stratified multistage random sampling. Methods the survey was conducted in eight (8) selected randomized sub-zonal communities across the western urban area in Sierra Leone, with an included sampling of 2394 adults. The WHO stepwise approach for non-communicable diseases was utilized. Multivariable logistic regression was done to determine associations between demographic characteristics and cardiovascular risk factors. Results The prevalence of hypertension (33.4% vs 37.4%, p=0.068), diabetes mellitus (7.4% vs 9.2%, p=0.101), overweight (32.3% vs 34.2%, p=0.323) and obesity (9.9% vs 10.2%, p=0.818) were higher among males in comparison to females. Body Mass Index (BMI) (25.0 ± 5.0 vs 24.6 ± 4.4, p = 0.029), waist circumference (WC) (93.6 ± 4.5 vs 80.0 ± 5.0, p < 0.001), triglyceride (1.7±0.35 vs 1.6±0.32, p=0.013), total cholesterol (5.1±0.77 vs 4.9±0.66, p < 0.001) and low HDL-C (1.28 ± 0.29 vs 1.3±0.24, p = 0.016) were significantly higher among females as compared to males. The odds of having dyslipidemia [OR = 1.339; 95% C.I: (1.101-1.629), p=0.003] and consuming alcohol [OR = 1.229; 95% C.I: (1.026-1.472), p =0.025] were higher among females. Women had 1.8 times greater odds [AOR=1.849; 95% C.I: (0.713 - 1.010), p =0.030] of being hypertensive, 1.4 times greater odds [AOR=1.441; 95% C.I: (1.176 - 1.765), p =<0.001] of being dyslipidemic and 1.2 times greater odds [AOR = 1.225, 95% C.I: (1.0123-1.481), p =0.037] of consuming alcohol compared to men. BMI, WC, and raised blood sugar had a strong correlation among women than men. Conclusion Being female was associated with a high prevalence of cardiovascular health risks in Sierra Leone. This study emphasizes the importance of reducing the CVD burden among females through policies related to public health education and screening strategies. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Ecobank Limited Sierra Leone ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Sierra Leone Ethics and Scientific Review Committee approved the research protocol, questionnaire, and consent form. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * BMI : Body Mass Index CMD : Cardiometabolic Disease CMRF : Cardiometabolic risk factors CVD : cardiovascular disease CVDRF : cardiovascular disease risk factors DBP : diastolic blood pressure LDL-C : Low-density lipoprotein cholesterol LMIC : low-and middle-income countries LVH : left ventricular hypertrophy LVMI : Left ventricular mass index NCD : Non-communicable disease HDL-C : High-density lipoprotein cholesterol SSA : Sub-Sahara African SBP : systolic blood pressure SLE : Leones currency TG : triglyceride TOD : target organ damage WC : waist circumference WHO : World Health Organization