Located in the Gauteng Province of South Africa (SA), Soweto is home to at least 1.1 million blacks and represents the largest black community in this sub-Saharan nation. Historically, its townships, spread over ≈40 sq miles of territory located to the southwest of Johannesburg, were created as a result of the residential segregation of blacks relocated to the area to work as cheap labor in the gold mines. Soweto has a history of poverty, overcrowding, and limited water supply, resulting in lifestyle factors such as communal toilets, along with a record of producing leaders of the international movement for sociopolitical transition in SA. Accordingly, any examination of the determinants, effects, prevention, and treatment of cardiovascular disease (CVD) must be framed within this sociopolitical context. Thus, the concept of “epidemiological transition,” which refers to a switch in disease prototype and the interrelations of the latter with the socioeconomic and demographic environment, applies to heart failure epidemiology in Soweto to the extent that the change in heart failure pattern is a result of evolving socioeconomic, cultural, technological, and other transitions. Article p 2360 In this issue of Circulation , Stewart et al1 provide data about the epidemiology of heart failure in Soweto among persons who presented to the Cardiology Unit of Chris Hani Baragwanath Hospital in 2006. Among 844 de novo presentations of heart failure and cardiomyopathy, hypertensive cardiomyopathy and idiopathic dilated cardiomyopathy represented >60% of the cases, a finding that is out of proportion to other causes of heart failure in the region. Moreover, the authors note that unlike the West, where ischemic heart disease is a major cause of heart failure, coronary artery disease accounted for only 9% of the causes of cardiomyopathy. Additionally, in this predominantly black population, young black women who tended to be obese made up …