In Africa, Heart Disease And Its Risk Factors Are Expanding

Many
types of heart disease as well as some of its associated risk factors,
which are traditionally only associated with high-income countries, are
increasing in incidence in African people. This is worsening the threat
to these populations and only deepening the challenges governments and
doctors must face in these areas. These conclusions were published in
an article in The Lancet released on March 14,
2008.? 



The
epidemic of cardiovascular disease (CVD) in developed countries has
been well documented, from its causes to its consequences. In
low-income and middle-income countries, where malnourishment and
infectious disease are also common, there are few data to describe
CVD's effects.



To explore this, the Heart of Soweto Study was
performed by Professor Simon Stewart, Cardiovascular Research Unit,
Chris Hani Baragwanath Hospital, University of the Witwatersrand,
Johannesburg, South Africa, and Baker Heart Research Institute,
Melbourne, Australia, and colleagues. The study focused on the clinical
range of disorders related to CVD in patients presenting for the first
time to a cardiology unit in Chris Hani Baragwanath Hospital in one
year. Data was recorded for 4,162 patients with confirmed CVD, 1,593 of
whom were newly diagnosed and 2,569 of whom were previously diagnosed
and under treatment. Additionally, they established a registry for
newly diagnosed patients with relevant data.



Upon examination
it was found that, of the newly diagnosed study
population,? 85%
(1,359) were black Africans and 59% (939) were women. In the same
population, women had an average age of 53 years, while men were older
with a mean of 55 years. Approximately 25% of the patients were younger
than 40 years old.



The most common primary diagnosis was heart
failure, and this was present in 44% of the patients. Compared to the
rest of the population, black Africans were 46% more likely to be
diagnosed with heart failure, but only 10% as likely to be diagnosed
with coronary artery disease. In general, the presence of CVD risk
factors was very high: 56% of the patients had hypertension or high
blood pressure; 44% of the patients with hypertension were obese. 59%
(933) newly diagnosed patients showed several risk factors, while only
8% (209) of this population showed no identifiable risk factors.



This
study, according to the authors, will have important implications on
actions taken to prevent and treat heart disease, not just in Soweto,
but also for other urban communities in Africa that are presently
experiencing similar epidemiological changes in their disease profiles.
Presently, a broad range of advanced conditions are included in the
spectrum of Soweto's heart disease. This includes the infectious
diseases usually expected in African populations, such as rheumatic
valvular diseases, cardiomyopathies, tuberculosis linked pericardial
effusion and diseases exacerbated by HIV incidence. However, also
included are newer non-communicable diseases that are associated with
advanced clinical presentation, which usually are reported in
high-income countries, such as hypertensive heart disease and coronary
artery disease.



The authors point out in particular their
concern that the patients most likely to be obese in both this hospital
and in the general community were black African women, and that this
group represents a greater proportion of the whole than black African
men. "[This] is especially noteworthy in view of the typical male
dominance seen in cohorts from developed countries."They conclude,
highlighting the final implications of their new data: "The combination
of common preventable risk factors and late clinical
presentations - especially heart failure - represents a particular
challenge to improve primary and secondary prevention strategies to not
only reduce the number of new cases of cardiovascular disease but also
improve health outcomes for those with pre-established disease."



Dr
Harvey White, Auckland City Hospital, New Zealand, and Dr Anthony
Dalby, Milpark Hospital, Johannesburg, South Africa, contributed an
accompanying Comment in which they point out the importance of
this study along with some challenges. They say: "The major challenge
is how to increase health resources. A recurring theme in Africa is the
lack of reliable statistics. This registry, from one of the largest
urban populations of black Africans, goes a long way to correcting that
deficit in Soweto."



Spectrum
of heart disease and risk factors in a black urban population in South
Africa (the Heart of Soweto Study): a cohort study

Karen Sliwa, David Wilkinson, Craig Hansen, Lucas Ntyintyane, Kemi
Tibazarwa, Anthony Becker, Simon Stewart

The Lancet - Vol. 371, Issue 9616, 15 March 2008,
Pages 915-922

DOI:10.1016/S0140-6736(08)60417-1

Click
Here For Abstract



Heart disease in Soweto: facing a triple threat

Harvey D White, Anthony J Dalby

The Lancet - Vol. 371, Issue 9616, 15 March 2008,
Pages 876-877

Click Here For Journal



Anna Sophia McKenney