Cardiovascular Disease In sub-Saharan Africa Research Articles

HIV is associated with endothelial activation despite ART, in a sub-Saharan African setting.

ObjectiveTo study the relationship between endothelial dysfunction, HIV infection, and stroke in Malawians.MethodsUsing a cross-sectional design, we measured plasma levels of intercellular adhesion molecule-1 (ICAM-1), plasminogen activator inhibitor-1 (PAI-1), vascular endothelial growth factor (VEGF), and soluble thrombomodulin (sTM) in stroke patients and controls, stratified by HIV status. These biomarkers were measured using ELISA. After dichotomization, each biomarker was used as the dependent variable in a multivariable logistic regression model. Primary independent variables included HIV and stroke status. Adjustment variables were age, sex, hypertension, diabetes mellitus, tobacco and alcohol consumption, personal/family history of stroke, antiretroviral therapy status, and hypercholesterolemia.ResultsSixty-one stroke cases (19 HIV+) and 168 controls (32 HIV+) were enrolled. The median age was 55 years (38.5–65.0) for controls and 52 years (38.0–73.0) for cases (p = 0.38). The median CD4+ T-cell count was 260.1 cells/mm3 (156.3–363.9) and 452 cells/mm3 (378.1–527.4) in HIV-infected cases and controls, respectively. HIV infection was independently associated with high levels of ICAM-1 (OR = 3.6, 95% CI: 1.3–10.6, p = 0.018) in controls but not in stroke cases even after excluding patients with a viral load >1,000 RNA copies/mL (OR = 4.1, 95% CI: 1.3–13.1, p = 0.017). There was no association between the clinical profiles of HIV-positive controls or HIV-positive stroke and high levels of PAI-1, VEGF, and sTM.ConclusionsHIV infection is associated with endothelial activation despite antiretroviral treatment. Our findings underscore the need for larger clinical cohorts to better understand the contribution of this perturbation of the endothelial function to the increasing burden of cardiovascular diseases in sub-Saharan Africa.

Tackling the Growing Burden of Cardiovascular Diseases in Sub-Saharan Africa.

Tackling the Growing Burden of Cardiovascular Diseases in Sub-Saharan Africa.

Primary Prevention of Coronary Artery Disease

There have been an estimated one million deaths from cardiovascular disease in sub-Saharan Africa in 2013. The deaths can in some part be prevented through the control of risk factors for coronary artery disease. The major modifiable risk factors in adults include: smoking, obesity, unhealthy diet, dyslipidaemia, hypertension and diabetes. This article aims discuss the primary prevention of coronary artery disease through examining the evidence regarding the control of these modifiable risk factors. It also briefly explains a pragmatic approach to the use of aspirin as primary prevention for coronary artery disease which takes into account both the risks and benefits associated with aspirin use.

The Burden of Cardiovascular Disease in Sub-Saharan Africa and the Black Diaspora.

For over four decades the National Medical Association (NMA) and the Association of Black Cardiologists (ABC) have sought to bring to national attention the disparate burden of cardiovascular disease (CVD) among African Americans. However, systematic inquiry has been inadequate into the burden of CVD in the poor countries of Sub-Saharan Africa (SSA) and the African diaspora in the Americas outside the USA. However, recently, the Global Burden of Disease Study (GBD) has offered new tools for such inquiry. Several initial efforts in that direction using 2010 data have been published. This article highlights some new findings for SSA for 2016. It also suggests that NMA and ABC further this effort by direct advocacy and collaboration with the GBD to make estimates of CVD burden in African Americans and South American Blacks explicitly available in future iterations.

Ten-year clinical experience of humanitarian cardiothoracic surgery in Rwanda: Building a platform for ultimate sustainability in a resource-limited setting

ObjectiveDespite its near complete eradication in resource-rich countries, rheumatic heart disease remains the most common acquired cardiovascular disease in sub-Saharan Africa. With a ratio of physicians/population of 1 per 10,500, including only 4 cardiologists for a population of 11.4 million, Rwanda represents a resource-limited setting lacking the local capacity to detect and treat early cases of strep throat and perform lifesaving operations for advanced rheumatic heart disease. Humanitarian surgical outreach in this region can improve the delivery of cardiovascular care by providing sustainability through mentorship, medical expertise, training, and knowledge transfer, and ultimately the creation of a cardiac center. MethodsWe describe the experience of consecutive annual visits to Rwanda since 2008 and report the outcomes of a collaborative approach to enable sustainable cardiac surgery in the region. The Ferrans and Powers Quality of Life Index tool's Cardiac Version (http://www.uic.edu/orgs/qli/) was administered to assess the postoperative quality of life. ResultsTen visits have been completed, performing 149 open procedures, including 200 valve implantations, New York Heart Association class III or IV, with 4.7% 30-day mortality. All procedures were performed with the participation of local Rwandan personnel, expatriate physicians, nurses, residents, and support staff. Early complications included cerebrovascular accident (n = 4), hemorrhage requiring reoperation (n = 6), and death (n = 7). Quality of life was assessed to further understand challenges encountered after cardiac surgery in this resource-limited setting. Four major domains were considered: health and functioning, social and economic, psychologic/spiritual, and family. The mean total quality of life index was 20.79 ± 4.07 on a scale from 0 to 30, for which higher scores indicated higher quality of life. Women had significantly lower “social and economic” subscores (16.81 ± 4.17) than men (18.64 ± 4.10) (P < .05). Patients who reported receiving their follow-up care in rural health centers also had significantly lower “social and economic” subscores (15.67 ± 3.81) when compared with those receiving follow-up care in urban health facilities (18.28 ± 4.16) (P < .005). Value afforded to family and psychologic factors remained high among all groups. Major postsurgical challenges faced included barriers to follow-up and systemic anticoagulation. ConclusionsThis report represents the first account of a long-term humanitarian effort to develop sustainability in cardiac surgery in a resource-limited setting, Rwanda. With the use of volunteer teams to deliver care, transfer knowledge, and mentor local personnel, the results demonstrate superior outcomes and favorable indices of quality of life. The credibility gained over a decade of effort has created the opportunity for a partnership with Rwanda to establish a dedicated center of cardiac care to assist in mitigating the burden of cardiovascular disease throughout sub-Saharan Africa.

Availability and Affordability of Essential Medicines and Diagnostic Tests for Diabetes Mellitus and Cardiovascular Diseases in Sub-Saharan Africa: A Systematic Review

Background: Diabetes mellitus (DM) and cardiovascular diseases (CVD) pose a significant health challenge in sub-Saharan Africa (SSA). Interventions to improve access to affordable essential medicines and diagnostic tests are needed to reduce morbidity and mortality due to these conditions. We performed this systematic review to evaluate the availability and affordability of essential medicines and diagnostic tests for DM and CVD in SSA, where health resources are particularly scarce. Methods: PubMed, Scopus and African Journal Online databases were searched for original research articles conducted in SSA between 2000 and March 2018 with information about availability and affordability of essential medicines and diagnostic tests for DM and CVD. Findings: Twenty cross sectional studies were identified with the majority performed in East African countries (n=12, 60%). Availability of insulin and oral hypoglycaemic agents (OHA) widely ranged from 0-100%. Angiotensin converting enzyme inhibitors, anti-platelet drugs and statins were available in 0-96.5%, 20.8-100% and 3.1-84% of surveyed health facilities respectively. Availability of blood glucose testing, glycated haemoglobin (HbA1c), electrocardiography (ECG) and troponin testing ranged from 6-100%, 20-43.5%, 9.1-81.8% and 0-43.2% respectively. The monthly cost of the majority of the lowest priced generic medicines and diagnostic tests was <3.5 days' wages. The cost of insulin, statins and unfractionated heparin widely ranged from 3.85-18.7 days' wages, 6.5-30.51 days' wages and 38.5-182.36 days' wages respectively. Interpretation: The availability and affordability of essential medicines and diagnostic tests for DM and CVD in SSA is suboptimal. Pragmatic solutions are urgently needed to address this challenge. Funding Statement: The authors declare: No funding was received for this work. Declaration of Interests: The authors declare no competing interests.

Influence of Health Education on Blood Pressure and Body Mass Index of Rural Dwellers IMO State

Background and objectives: Hypertension has been globally recognized as the most prevalent Cardiovascular Disease (CVD) and a potent risk factor in the development of other CVD outcomes such as coronary heart diseases, stroke, and renal insufficiency. It has been reported to be on the increase in recent years, being the most rapidly rising CVD in Sub-Saharan Africa. Meanwhile it is associated with preventable risk factors as salt, alcohol and obesity. The purpose of the study is to screen participants for high blood pressure and BMI, provide information on healthy lifestyles as a measure to reduce risk factors that predispose to hypertension among the populace.Methods: This work was an intervention study that adopted quasi experimental design in which only the Experimental Group (EG) was exposed to health education package aimed at lifestyle modification. Study was guided by three objectives and four hypotheses based on objective.Results: Percentage of participants with normal blood pressure reading in the EG increased from 37% at baseline to 47% at end-line unlike the Control Group (CG). There was significant difference between the blood pressure readings of the EG and CG, P value=0.000 but there was no significant difference between the BMI of the EG and CG, p value>0.05.Interpretation and conclusion: This implies that health education influenced their lifestyles positively. There was no significant change in BMI as obesity was not a problem among the populace. Awareness through Health Education on healthy lifestyles especially importance of DASH diet need to be intensified in rural communities by Health workers.

The association between HIV and atherosclerotic cardiovascular disease in sub-Saharan Africa: a systematic review

BackgroundSub-Saharan Africa (SSA) has confronted decades of the HIV epidemic with substantial improvements in access to life-saving antiretroviral therapy (ART). Now, with improved survival, people living with HIV (PLWH) are at increased risk for non-communicable diseases (NCDs), including atherosclerotic cardiovascular disease (CVD). We assessed the existing literature regarding the association of CVD outcomes and HIV in SSA.MethodsWe used the PRISMA guidelines to perform a systematic review of the published literature regarding the association of CVD and HIV in SSA with a focus on CVD surrogate and clinical outcomes in PLWH.ResultsFrom January 2000 until March 2017, 31 articles were published regarding CVD outcomes among PLWH in SSA. Data from surrogate CVD outcomes (n = 13) suggest an increased risk of CVD events among PLWH in SSA. Although acute coronary syndrome is reported infrequently in SSA among PLWH, limited data from five studies suggest extensive thrombus and hypercoagulability as contributing factors. Additional studies suggest an increased risk of stroke among PLWH (n = 13); however, most data are from immunosuppressed ART-naïve PLWH and thus are potentially confounded by the possibility of central nervous system infections.ConclusionsGiven ongoing gaps in our current understanding of CVD and other NCDs in PLWH in SSA, it is imperative to ascertain the burden of CVD outcomes, and to examine strategies for intervention and best practices to enhance the health of this vulnerable population.

Primary care in the prevention, treatment and control of cardiovascular disease in sub-Saharan Africa.

SummaryCardiovascular disease (CVD) is the frontrunner in the disease spectrum of sub-Saharan Africa, with stroke and ischaemic heart disease ranked seventh and 14th as leading causes of death, respectively, on this sub-continent. Unfortunately, this region is also grappling with many communicable, maternal, neonatal and nutritional disorders. Limited resources and the high cost of CVD treatment necessitate that primary prevention should have a high priority for CVD control in sub- Saharan Africa. One major challenge of such an approach is how to equip primary care to respond promptly and effectively to this burden. We present a practical approach on how primary care in sub-Saharan Africa could effectively address the prevention, treatment and control of CVD on the subcontinent. For effective prevention, control and treatment of CVD in sub-Saharan Africa, there should be strategic plans to equip primary care clinics with well-trained allied healthcare workers who are supervised by physicians.

Regional and Sex Differences in the Prevalence and Awareness of Hypertension: An H3Africa AWI-Gen Study Across 6 Sites in Sub-Saharan Africa.

There is a high prevalence of hypertension and related cardiovascular diseases in sub-Saharan Africa, yet few large studies exploring hypertension in Africa are available. The actual burden of disease is poorly understood and awareness and treatment to control it is often suboptimal. The study sought to report the prevalence of measured hypertension and to assess awareness and control of blood pressure among older adults in rural and urban settings in 6 sites located in West, East, and Southern Africa. In addition, we examined regional, sex, and age differences related to hypertension. A population-based cross-sectional study was performed at 6 sites in 4 African countries: Burkina Faso (Nanoro), Ghana (Navrongo), Kenya (Nairobi), and South Africa (Agincourt, Dikgale, Soweto). Blood pressure measurements were taken using standardized procedures on 10,696 adults 40 to 60 years of age. Hypertension was defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or taking antihypertensive medication. The mean prevalence of hypertension ranged from 15.1% in Nanoro to 54.1% in Soweto. All 3 of the South African sites had a mean prevalence of hypertension of over 40.0%, significantly higher than in Nairobi (25.6%) and Navrongo (24.5%). Prevalence increased with age in both sexes and at all sites. A significantly higher prevalence of hypertension was observed in women in Agincourt, Dikgale, and Nairobi, whereas in Nanoro this trend was reversed. Within the hypertensive group the average proportion of participants who were aware of their blood pressure status was only 39.4% for men and 53.8% for women, and varied widely across sites. Our study demonstrates that the prevalence of hypertension and the level of disease awareness differ not only between but also within sub-Saharan African countries. Each nation must tailor their regional hypertension awareness and screening programs to match the characteristics of their local populations.

HIV and risk of cardiovascular disease in sub-Saharan Africa: Rationale and design of the Ndlovu Cohort Study.

Background The largest proportion of people living with HIV resides in sub-Saharan Africa (SSA). Evidence from developed countries suggests that HIV infection increases the relative risk of cardiovascular disease (CVD) by up to 50%. Differences in lifestyle, gender distribution, routes of HIV transmission and HIV subtype preclude generalisation of data from Western countries to the SSA situation. The Ndlovu Cohort Study aims to provide insight into the burden of cardiovascular risk factors and disease, the mechanisms driving CVD risk and the contribution of HIV infection and its treatment to the development of CVD in a rural area of SSA. Design The Ndlovu Cohort Study is a prospective study in the Moutse area, Limpopo Province, South Africa. Methods A total of 1000 HIV-positive and 1000 HIV-negative participants aged 18 years and older with a male to female ratio of 1:1 will be recruited. Measurements of CVD risk factors and HIV-related characteristics will be performed at baseline, and participants will be followed-up over time at 6-month intervals. The burden of CVD will be assessed with repeated carotid intima-media thickness and pulse wave velocity measurements, as well as by recording clinical cardiovascular events that occur during the follow-up period. Conclusion This project will contribute to the understanding of the epidemiology and pathogenesis of CVD in the context of HIV infection in a rural area of SSA. The ultimate goal is to improve cardiovascular risk prediction and to indicate preventive approaches in the HIV-infected population and, potentially, for non-infected high-risk populations in a low-resource setting.

The burden of cardiovascular disease in Sub-Saharan Africa

The burden of cardiovascular disease (CVD) in Africa is growing and changing in nature. From the predominance of rheumatic heart disease and cardiomyopathies 50 years ago to hypertensive heart disease and haemorrhagic stroke in the past 25 years. Albeit at low prevalence, an increase in incidence of ischaemic heart disease is now being seen, particularly in urban areas. These changes in the extent and nature of CVD are thought to be the result of the so-called “epidemiological transition”. The challenge for health promotion and prevention is to accelerate the course of that transition and blunt its magnitude in order to avoid the massive epidemics of CVD that were seen in Europe and the USA in the mid-twentieth century.

Cardiovascular imaging in South Africa: Is the heartache easing?

There is an escalation in the prevalence of cardiovascular disease in sub-Saharan Africa. The radiology community of South Africa plays an important role in curbing this epidemic. Cardiovascular magnetic resonance is now regarded as a very important tool in our diagnostic armamentarium, and in this issue some of the established applications, as well as exciting new developments, are discussed.

Measurement of overweight and obesity an urban slum setting in sub-Saharan Africa: a comparison of four anthropometric indices.

BackgroundAs a result of both genetic and environmental factors, the body composition and topography of African populations are presumed to be different from western populations. Accordingly, globally accepted anthropometric markers may perform differently in African populations. In the era of rapid emergence of cardio-vascular diseases in sub-Saharan Africa, evidence about the performance of these markers in African settings is essential. The aim of this study was to investigate the inter-relationships among the four main anthropometric indices in measuring overweight and obesity in an urban poor African setting.MethodsData from a cardiovascular disease risk factor assessment study in urban slums of Nairobi were analyzed. In the major study, data were collected from 5190 study participants. We considered four anthropometric markers of overweight and obesity: Body Mass Index, Waist Circumference, Waist to Hip Ratio, and Waist to Height Ratio. Pairwise correlations and kappa statistics were used to assess the relationship and agreement among these markers, respectively. Discordances between the indices were also analyzed.ResultsThe weighted prevalence of above normal body composition was 21.6 % by body mass index, 28.9 % by waist circumference, 45.5 % by waist to hip ratio, and 38.9 % by waist to height ratio. The overall inter-index correlation was +0.44. Waist to hip ratio generally had lower correlation with the other anthropometric indices. High level of discordance exists between body mass index and waist to hip ratio. Combining the four indices shows that 791 (16.1 %) respondents had above normal body composition in all four indices. Waist circumference better predicted hypertension and hyperglycemia while waist to height ratio better predicted hypercholesterolemia.ConclusionsThere exists a moderate level of correlation and a remarkable level of discordance among the four anthropometric indices with regard to the ascertainment of abnormal body composition in an urban slum setting in Africa. Waist circumference is a better predictor of cardio-metabolic risk.

Patterns of international collaboration in cardiovascular research in sub-Saharan Africa.

The rising prevalence of cardiovascular disease in sub-Saharan Africa (SSA) constitutes a significant health and socio-economic challenge for the countries in the region. This study examines the patterns and scientific impact of international collaboration in cardiovascular research (CVR) in SSA. Bibliographic data from 2005 to 2014 were obtained from the Web of Science for cardiovascular-related publications with at least one author affiliated to an SSA country. The number of publications involving multiple SSA countries over this period accounted for less than 10% of the total number of multicountry publications that included at least one SSA country. Collaboration patterns reflected dominance by countries in Europe and North America, with South Africa accounting for the bulk of scientific collaboration in CVR within SSA. The findings indicate that pro-active strategies are needed to strengthen collaboration in CVR across SSA for the region to derive health and socio-economic benefits from locally conducted research.

Prevalence and factors associated with hyperuricaemia in newly diagnosed and untreated hypertensives in a sub-Saharan African setting

Few studies have evaluated the link between hyperuricaemia and cardiovascular disease in sub-Saharan Africa. To assess the prevalence of and factors associated with hyperuricaemia among newly diagnosed treatment-naïve hypertensive patients in sub-Saharan Africa. We performed a community-based cross-sectional study from January to December 2012 in Douala, Cameroon (Central Africa). We enrolled newly diagnosed treatment-naïve hypertensive patients, and excluded those with gout or a history of gout. Serum uric acid concentrations were measured by enzymatic colourimetric methods, and hyperuricaemia was defined as a serum uric acid concentration>70IU/mL. Fasting blood sugar concentrations, serum creatinine concentrations and lipid profiles were also measured. Logistic regression was used to study factors associated with hyperuricaemia. We included 839 newly diagnosed treatment-naïve hypertensive patients (427 women and 412 men; mean age 51±11 years; mean serum uric acid concentration 60.5±16.5IU/L). The prevalence of hyperuricaemia was 31.8% (95% confidence interval [CI] 28.7-34.9) and did not differ by sex (132 women vs. 135 men; P=0.56). Multivariable logistic regression identified age>55 years (adjusted odds ratio [AOR] 1.65, 95% CI 1.12-2.29), family history of hypertension (AOR 1.65, 95% CI 1.01-2.67), waist circumference>102cm in men or>88cm in women (AOR 1.60, 95% CI 1.12-2.29), low-density lipoprotein cholesterol>1g/L (AOR 1.33, 95% CI 0.97-1.82) and triglycerides>1.5g/L (AOR 1.63, 95% CI 1.01-2.65) as independently associated with hyperuricaemia. Hyperuricaemia is common among newly diagnosed treatment-naïve hypertensive patients in sub-Saharan Africa and is associated with some components of the metabolic syndrome.

Cost of management of nonvalvular atrial fibrillation in Brazzaville (Congo): preliminary findings.

The frequency of nonvalvular atrial fibrillation is increasing in sub-Saharan Africa, particularly as a consequence of population aging and the high prevalence of hypertension. The aim of this descriptive study was to determine the cost of management of this disease in the cardiology department at University Hospital of Brazzaville. The study included 50 patients aged 67.3±12.8 years (range: 34 to 88 years). Among them, 21 (42%) were unemployed, and 49 (98%) had no health insurance. Their average monthly salary was 152.8±149€ (range: 0 to 686€). The mean total cost of care was 442.4±109.8 € (range: 146.6 to 646.2 €). The average monthly salary was higher than the average cost of drugs (P<0.0001), or of additional tests (P<0.0001), or of hospital hospitality (P<0.0001). But the overall cost of care was substantially higher than the patients' mean salary (p<0.0001). This study illustrates the increasing healthcare costs related to the growing burden of cardiovascular disease in sub-Saharan Africa.

Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

BackgroundHypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care.ObjectiveWe explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria.DesignQualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques.ResultsBoth stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider–insurer relationships; automated administration systems; and tailoring guidelines/patient education.ConclusionsBy providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA.

Cardiovascular Disease Risk Associated to Chronic Inflammatory Rheumatic Diseases in Patients Seen in Rheumatology Unit in Yaounde, Cameroon

Introduction: Even though there is a huge burden of both chronic inflammatory rheumatic diseases (CIRD) and cardiovascular diseases in Sub-Saharan Africa, no published study from this region has yet addressed the issue of cardiovascular diseases in a group including different CIRD to the best of our knowledge. Objective: We conducted this research with the aim to explore the association between CIRD and cardiovascular risk in a Cameroonian population based on the World Health Organization (WHO) and International Society for Hypertension (ISH) risk charts. Methods: This cross-sectional study included CIRD patients, followed at the rheumatology unit of the Yaounde Central Hospital, and, who were matched to non-CIRD subjects for sex, age and race. Cardiovascular risk factors were studied and subsequently the cardiovascular risk was estimated using the WHO/ISH risk charts. Analyses were performed in Epi-info and SPSS software and results were considered statistically significant for a p-value less than 0.05. Results: In total, 109 CIRD patients and 111 non-CIRD subjects were included. Their respective mean ages were 44.4 ± 15.2 years and 44.2 ± 15.1 years. Odds ratio 2.09, 95% confidence interval (CI) (1.07 - 4.08); high BMI OR 1.89, 95% CI (1.1 - 3.24); diabetes mellitus (p = 0.03) and physical inactivity (p < 0.001) were all markedly found in CIRD patients compared with controls. Ten (9.2%) CIRD patients had a past history of atherosclerotic cardiovascular events compared with no control (p < 0.001). The cardiovascular risk estimated with the WHO/ISH risk charts was low in 43 (79.6%) patients with CIRD versus 52 (88.1%) non-CIRD subjects. Conclusions: CIRD were associated with hypertension, excess overall adiposity, diabetes mellitus, and physical inactivity. A substantially increased proportion of CIRD patients with a past history of atherosclerotic cardiovascular events were noted. But the WHO/ISH risk charts broadly found a similar and globally decremented cardiovascular risk in both study groups, highlighting the need to pursue research for definite conclusions on their reliability.

Institution-level collaboration in cardiovascular research in sub-Saharan Africa.

The contribution of sub-Saharan Africa to scientific knowledge on cardiovascular disease (CVD) prevention and care is very limited compared to other regions of the world. This underlies the challenge of understanding and addressing the high prevalence of risk factors for CVD in sub-Saharan Africa. The patterns of collaboration between institutions in the region in the area of cardiovascular research are not well documented, although there is evidence of significant collaboration in health research between Africa-based researchers and those in countries outside the region. This study focuses on mapping the linkages between institutions in this region using co-authorship of publications in cardiovascular research from 2005 to 2014. The key institutions in sub-Saharan Africa which engaged in collaboration are identified and the potential of these networks for stimulating the growth of research capacity in this field is discussed.