A systematic review and meta-analysis of cardiovascular diseases and associated factors among diabetes mellitus patients in Ethiopia

(2023) 23:413 Ayalew et al. BMC Cardiovascular Disorders https://doi.org/10.1186/s12872-023-03443-0 BMC Cardiovascular Disorders Open Access RESEARCH A systematic review and meta‑analysis of cardiovascular diseases and associated factors among diabetes mellitus patients in Ethiopia Tadele Lankrew Ayalew1*, Kirubel Eshetu Haile1, Mulualem Gete Feleke1, Bitew Tefera Zewudie1 and Tesfaye Yitna Chichiabellu2 Abstract Background Cardiovascular disease (CVD) is the most prevalent complication and the leading cause of death and disability among patients with diabetes mellitus (DM). Over time, diabetes-related cardiovascular disease has become more common worldwide. The aim of this study was to determine the cumulative prevalence of cardiovascular disease and associated factors among diabetic patients in Ethiopia. Objective The main aim of this review was to estimate the pooled prevalence of cardiovascular disease and its associated factors among diabetic patients in Ethiopia. Methods and materials This review was searched using PubMed, Google, and Google Scholar search engines, and was accessed using medical subject heading (MeSH) terms for studies based in Ethiopia. Excel was used to extract the data. With a random-effects model, STATA Version 14 was used for all statistical analyses. The studies’ heterogeneity and funnel plot were both examined. The study domain and authors’ names were used in the subgroup analysis. Results In this systematic review, 12 studies totaling 2,953 participants were included. The estimated overall prevalence of cardiovascular disease among diabetic patients in Ethiopia was 37.26% (95% CI: 21.05, 53.47, I2 = 99.3%, P ≤ 0.001). Study participants’ age older than 60 years (AOR = 4.74, 95%CI: 1.05, 8.43), BMI > 24.9kg/m2 (AOR = 4.12, 95% CI: 2.33, 5.92), triglyceride > 200mg/dl (AOR = 3.05, 95% CI: 1.26, 4.83), Hypertension (AOR = 3.26, 95% CI: 1.09, 5.43) and duration of DM > 4 years (AOR = 5.49, 95% CI: 3.27, 7.70) were significantly associated with cardiovascular disease. Conclusions In conclusion, diabetic patients face a serious public health risk from cardiovascular disease. This review found the following factors, which is independent predictors of cardiovascular disease in diabetic patients: age over 60, BMI > 24.9kg/m2, triglycerides > 200 mg/dl, hypertension, and diabetes duration > 4 years. The results emphasize the need for a prospective study design with a longer follow-up period to assess the long-term effects of CVD predictors in diabetic patients as well as the significance of paying attention to cardiovascular disease in diabetic patients with comorbidity. Keywords Cardiovascular disease, Diabetes mellitus, Ethiopia *Correspondence: Tadele Lankrew Ayalew Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Ayalew et al. BMC Cardiovascular Disorders (2023) 23:413 Introduction Non-communicable diseases (NCDs) have surpassed infectious diseases as the leading cause of death worldwide, accounting for about 36 million fatalities annually [1]. Cardiovascular disease (CVD) is the main danger to human health and development, followed by cancer, persistent respiratory conditions, and diabetes. About 35 million people per year die from it, with poorer nations accounting for 85% of those deaths [2]. The word "CVDs" refers to a set of diseases and injuries that have an impact on the heart and the tissues that support it. Deep vein thrombosis (DVT), stroke, angina, congestive heart failure, coronary heart disease, and peripheral arterial disease are only a few of the conditions referred to as "CVDs" (but they are not the only ones) [2, 3]. The main cause of early death and disability in diabetic people is CVDs [4]. This has a substantial effect on the rising expense of healthcare. According to studies, the proportion of people who die from CVDs before their time ranges from 42% in low-income countries to 4% in high-income countries, showing the growing disparities between the populations living in different countries [4–6]. Obesity, poor diet, high blood pressure, and diabetes mellitus are common, and their prevalence is rising more quickly than their burden can be alleviated. Despite the fact that CVD is preventable, it is responsible for around 31% of all fatalities globally, and more than 3 million of those deaths occurred before the age of 60 year [2, 7–9]. In low- and middle-income nations, almost 80% of fatalities from CVD-related causes occurred. According to the Global Disease Burden Report 2015, population growth and aging have led to a rise in the percentage of CVDrelated mortality in many of the world’s poorer regions. In Eastern and Central Sub-Saharan Africa, the disease is more common than in Western and Southern Sub-Saharan Africa [2, 7, 10, 11]. Excessive alcohol use, energy-dense diets, hypercholesterolemia, diabetes, sedentary lifestyles, overweight/ obesity, age, sex, family history, and ethnicity are only a few of the numerous and diverse causes of CVD [2, 12, 13]. Due to the necessity for information on persons who do not attend the medical institution, it is notoriously difficult to estimate the prevalence of CVD in a population. It is challenging to quantify the global prevalence of CVD due to the fact that different nations report prevalence that was evaluated using various approaches. Estimating the CVD burden is very challenging in sub-Saharan African countries like Ethiopia [2, 14, 15]. The World Health Organization estimates that non-communicable diseases caused 30% of deaths in Ethiopia in 2014, with cardiovascular disease being responsible for 9% of these fatalities [2, 11]. Page 2 of 14 Diabetes-related premature mortality increased by 5% between 2000 and 2016. Between 2000 and 2019, the age-standardized death rates from diabetes rose by 3%. Notably, cardiovascular (CV) events are a leading factor in the increased risk of (...truncated)