Abstract
The epidemiology of ischaemic heart disease (IHD) in sub-Saharan Africa (SSA) remains largely enigmatic. Major obstacles to our understanding of the condition include lack of reliable health statistics, particularly cause-specific mortality data, inadequate diagnostic capabilities, shortage of physicians and cardiologists, and misguided opinions. This review of the epidemiology of ischaemic heart disease in sub-Saharan Africa involved a systematic bibliographic MEDLINE search of published data on IHD in SSA over the past century. Search words included epidemiology, ischaemic (coronary) heart disease, myocardial infarction, cardiovascular risk factors and sub-Saharan Africa. Selected data are presented on the prevalence of cardiovascular risk factors and mortality from ischaemic heart disease from different countries representing the main regions of the continent. Although IHD in SSA remains relatively uncommon, its prevalence is predicted to rise in the next two decades due to the rising prevalence of risk factors, especially hypertension, diabetes, overweight and obesity, physical inactivity, increased tobacco use and dyslipidaemia. It is estimated that age-standardised mortality rates for IHD will rise by 27% in African men and 25% in women by 2015, and by 70 and 74%, respectively by 2030. Ischaemic heart disease remains relatively uncommon in SSA, despite an increasing prevalence of risk factors, but its incidence is rising. The pace and direction of economic development, rates of urbanisation, and changes in life expectancy resulting from the impact of pre-transitional diseases and violence will be major determinants of the IHD epidemic in SSA. The best window of opportunity for prevention of the emerging epidemic of ischaemic heart disease in sub-Saharan Africa is now.
Highlights
The epidemiology of ischaemic heart disease (IHD) in sub-Saharan Africa (SSA) remains largely enigmatic
Untreated HIV infection may have a paradoxical overall effect on cardiovascular disease and thereby reduce the risk of ischaemic heart disease because of severe and progressive weight loss, wasting syndrome, hypotension resulting from chronic gastroenteritis, hypoadrenalism and shortened life expectancy associated with advanced acquired immunodeficiency syndrome (AIDS)
The findings of the INTERHEART African study were at slight variance with reports by Ezzati and colleagues who showed that hypertension, low intake of fruits and vegetables and physical inactivity accounted for populationattributable fractions for ischaemic heart disease mortality of 43, 25 and 20%, respectively, in the Africa region
Summary
Major obstacles to our understanding of IHD in SSA include lack of reliable statistics on health, life expectancy and disease incidence, and the absence of cause-specific mortality data. This is confounded by lack of diagnostic capabilities in most of SSA, emanating from a shortage of physicians, cardiologists, and lack of appropriate investigations, such as AFRIC A CARDIOVASCULAR JOURNAL OF AFRICA Vol 24, No 2, March 2013 resting 12-lead electrocardiographs (ECGs), exercise ECGs, cardiac biomarkers (troponins, CKMB) and cardiac imaging such as echocardiography, coronary angiography, computed tomography (CT) angiography, intravascular ultrasound scans (IVUS) and radionuclide myocardial perfusion studies. In 2000, the urbanisation rate had risen to 37.2%, and by 2015 the rate is expected to hit 45.3% with continually high rates of rural–urban migrations across Africa.[10]
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