Soweto Study Research Articles

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

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

New perspectives on the causes and consequences of heart failure in a black urban population in South Africa: The Heart of Soweto Study

New perspectives on the causes and consequences of heart failure in a black urban population in South Africa: The Heart of Soweto Study

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

The Heart of Soweto Study aims to increase our understanding of the characteristics and burden imposed by heart disease in an urban African community in probable epidemiological transition. We aimed to investigate the clinical range of disorders related to cardiovascular disease in patients presenting for the first time to a tertiary-care centre. From Jan 1 to Dec 31, 2006, we recorded data for 4162 patients with confirmed cases of cardiovascular disease (1593 newly diagnosed and 2569 previously diagnosed and under treatment) who attended the cardiology unit at the Chris Hani Baragwanath Hospital in Soweto, South Africa. We developed a prospectively designed registry and gathered detailed clinical data relating to the presentation, investigations, and treatment of all 1593 patients with newly diagnosed cardiovascular disease. Most patients were black Africans (n=1359 [85%]), and the study population contained more women (n=939 [59%]) than men. Women were slightly younger than were men (mean 53 [SD 16] years vs 55 [15] years; p=0.031), with 399 (25%) patients younger than 40 years. Heart failure was the most common primary diagnosis (704 cases, 44% of total). Moderate to severe systolic dysfunction was evident in 415 (53%) of 844 identified cases of heart failure, 577 (68%) of which were attributable to dilated cardiomyopathy or hypertensive heart disease, or both. Black Africans were more likely to be diagnosed with heart failure than were the rest of the cohort (739 [54%] vs 105 [45%]; odds ratio [OR] 1.46, 95% CI 1.11-1.94; p=0.009) but were less likely to be diagnosed with coronary artery disease (77 [6%] vs 88 [38%]; OR 0.10, 0.07-0.14; p<0.0001). Prevalence of cardiovascular risk factors was very high, with 897 (56%) patients diagnosed with hypertension (190 [44%] of whom were also obese). Only 209 (13%) patients had no identifiable risk factors, whereas 933 (59%) had several risk factors. We noted many threats to the present and future cardiac health of Soweto, including a high prevalence of modifiable risk factors for atherosclerotic disease and a combination of infectious and non-communicable forms of heart disease, with late clinical presentations. Overall, our findings provide strong evidence that epidemiological transition in Soweto, South Africa has broadened the complexity and spectrum of heart disease in this community. This registry will enable continued monitoring of the range of heart disease.

A time bomb of cardiovascular risk factors in South Africa: Results from the Heart of Soweto Study “Heart Awareness Days”

Background There is strong anecdotal evidence that many urban communities in Sub-Saharan Africa are in epidemiologic transition with the subsequent emergence of more affluent causes of heart disease. However, data to describe the risk factor profile of affected communities is limited. Methods During 9 community screening days undertaken in the predominantly Black African community of Soweto, South Africa (population 1 to 1.5 million) in 2006–2007, we examined the cardiovascular risk factor profile of volunteers. Screening comprised a combination of self-reported history and a clinical assessment that included calculation of body mass index (BMI), blood pressure and random blood glucose and total cholesterol levels. Results In total, we screened a total of 1691 subjects (representing almost 0.2% of the total population). The majority (99%) were Black African, there were more women (65%) than men and the mean age was 46 ± 14 years. Overall, 78% of subjects were found to have ≥ 1 major risk factor for heart disease. By far the most prevalent risk factor overall was obesity (43%) with significantly more obese women than men (23% versus 55%: OR 1.76 95% CI 1.62 to 1.91: p < 0.001). A further 33% of subjects had high blood pressures (systolic or diastolic) and 13% an elevated (non-fasting) total blood cholesterol level: no statistically significant differences between the sexes were found. There was a positive correlation between increasing BMI and other risk factors including elevated systolic ( r 2 = 0.046, p < 0.001) and diastolic blood pressure ( r 2 = 0.032, p < 0.001) with overweight subjects three times more likely to have concurrent hypercholesterolemia (OR 3.3, 95% CI 2.1 to 5.3: p < 0.01). Conclusions These unique pilot data strongly suggest a high prevalence of related risk factors for heart disease in this urban black African population in epidemiologic transition. Further research is needed to confirm our findings and to determine their true causes and potential consequences.

Social aspects of living with rheumatoid arthritis: a qualitative descriptive study in Soweto, South Africa – a low resource context

BackgroundRheumatoid Arthritis (RA) is a chronic illness with important functional, social and employment consequences. We therefore undertook a cross-sectional study, using the International Classification of Functioning, Disability and Health framework, to investigate the personal and social consequences of RA in women, living under largely impoverished conditions.MethodsA qualitative case study design was used with a convenience sample of 60 women with RA living in Soweto, South Africa. Semi-structured in-depth interviews were conducted to cover a range of experiences including onset of disease, treatment, environmental barriers and facilitators, employment, and social inclusion in family and community life. The outcomes are described according the International Classification of Functioning, Health and Disability framework at the body, person and societal levels and looking at both personal and environmental factors.ResultsThe main features of living with RA were pain, muscle stiffness at the body level, difficulties in doing various activities such as mobility, washing, dressing, domestic activities, using transport and obtaining and maintaining employment at the person level. At the societal level the participants described difficulties moving around, interacting socially and taking part in community activities, fulfilling social roles and earning a living. Environmental facilitators such as assistive devices and health care services improved functioning. Barriers such as physical environments, lack of transport and basic services, such as electricity, and attitudes of others lead to social exclusion, loss of a sense of self and independence. Low income, lack of sufficient public transport, and sparse basic services were poverty features that exacerbated negative experiences.ConclusionThe experiences of living with RA in a low resource context are similar to those in mid- and high resource contexts, but are exacerbated by poverty and the lack of basic services. Pain and social exclusion are some of the key experiences of women with RA living in Soweto. The ICF provides a useful framework for describing and understanding the complexity of these experiences.

A Broad Spectrum of Heart Disease and Risk Factors in a Black Urban Population in South Africa: The Heart of Soweto Study

A Broad Spectrum of Heart Disease and Risk Factors in a Black Urban Population in South Africa: The Heart of Soweto Study

Sex-based Differences in the Pattern of Hypertension-related Heart Disease in a Black African Urban Community: The Heart of Soweto Study

Sex-based Differences in the Pattern of Hypertension-related Heart Disease in a Black African Urban Community: The Heart of Soweto Study

Evidence to Support the Emergence of New Forms of Heart Failure in Africa: The Heart of Soweto Study

Background: The Heart of Soweto Study is the largest study of emergent heart disease (HD) in Africa. Methods: Baragwanath Hospital in Soweto provides health care to a population of 1.1 million mainly black Africans. We registered detailed demographic, clinical anddiagnostic data fromall denovopresentations of heart disease (HD) in 2006. Results: In 2006, 844 patients presented with de novo heart failure HF. Women (57%) and black Africans (88%) predominated: 90%had≥1 risk factor, includinghypertension and obesity (34%). Mean left ventricular ejection fraction was 45± 18%, 53% and 27%, respectively had systolic and diastolic dysfunction. The most common forms of HF were dilated CMO (35%), hypertensiveHF (33%), right HF (27%), ischaemic CMO (9%) and valvular HF (8%). Adjusting for age, race and risk factor profile, women had less ischaemic CMO (OR 0.49, 95% CI 0.28–0.85: p= 0.011) but more right HF (OR 1.40, 95% CI 0.99–1.98: p= 0.051) comlarge bowel cancer (25,722 men and 25,992 women) and lung cancer (21,636 men and 12,945 women) were compared. Results: The ratio of patients with HF compared to the six most common forms of cancer (large bowel, lung, prostate, breast, bladder, and ovarian) was 1.5:1 (321,951 vs. 218,664 cases). For patients aged 60 years, the rate of 5year survivalwas 70%and75% inmenandwomenwithHF compared to 57%and61%, respectively, in thosewith large bowel cancer and 18%and 20%, respectively for thosewith lung cancer. Odds ratios for a one-year increment of calendar year, showed that 5-year survival had significantly increased by 7.1% (95% CI 6.8–7.4%) and 6% (5.7–6.4%) per year for men and women with HF and 3.2% (2.4–3.9%) and 2.6% (1.8–3.3%), respectively, per year for large bowel cancer. Five-year survival in both men (odds ratio of 1.01: 0.99–1.02) and women (odds ratio of 1.00: 0.98–1.01) with a first-time diagnosis of lung cancer remained static. Conclusion: These preliminary data suggest that heart failure has become less malignant than many common forms of cancer in Sweden.

Every ECG tells a story: ECG characteristics of heart of Soweto study patients with heart failure

Every ECG tells a story: ECG characteristics of heart of Soweto study patients with heart failure

Mapping the emergence of heart disease in a black, urban population in Africa: The Heart of Soweto Study

Background There is increasing evidence that many populations in the developing world are in “epidemiologic transition” with the subsequent emergence of more “affluent” disease states. The “Heart of Soweto Study” will systematically investigate the emergence of heart disease (HD) in a large urban population in South Africa. Methods Part of the conurbation of Johannesburg, South Africa, Soweto is a predominantly Black African community of 1 million individuals. During an initial two year period, all individuals presenting to the local Baragwanath Hospital (3500 beds) with any form of HD will be studied. Demographic and diagnostic coding data in those with pre-established HD will form an abbreviated clinical registry of > 12,000 “prevalent” cases. Similarly, socio-demographic, clinical and diagnostic data (e.g. echocardiography and ECG) in newly diagnosed patients will form a more detailed clinical registry of > 5000 “incident” cases. Sub-studies of the relationship between HIV status and HD and the optimal management of chronic heart failure will also be performed. Results These data will provide a unique insight into the causes and consequences of a broad spectrum of HD-related conditions in a “developing world” community in epidemiologic transition. Initially documented population rates, in addition to detailed examinations of the underlying risk factors and causes of HD-related morbidity/mortality will provide an important platform for future stages of the study: a community-based, population screening program and culturally specific primary and secondary programs of care. Conclusion There is an urgent need to systematically track the emergence of HD in the developing world. Initially involving more than 15,000 individuals, the unique Heart of Soweto Study has the potential to provide a wealth of information in this regard.