Research Projects
Forgotten cardiovascular disease in Africa
Much of the global burden of disease is now carried by low- and middle-income countries. In addition Africa has unique cardiovascular diseases that occur more commonly in Africans. Examples are peripartum cardiomyopathy, endomyocardial fibrosis and subvalvular aneurysm. Patients often present only in advanced heart failure because of poor access to good healthcare. (Download PDF)
Sliwa K, Mocumbi AO, Forgotten Cardiovascular Diseases in Africa. Clin Res Cardiol. 2009, Epub, DOI 10.1007/S00392-009-00941.
Burden of Heart Failure in Soweto – The Heart of Soweto Study
Chris Hani Baragwanath Hospital services the 1.1 million black African community of Soweto, South Africa. Of 1960 cases of HF and related cardiomyopathies (CMO) in 2006, we prospectively collected detailed demographic and clinical data from all 844 de novo presentations (43%). Mean age was 55 ± 16 years while women (479 [57%]) and black Africans (739 [88%]) predominated. Most (761 [90%]) had ≥ 1 cardiovascular risk. Mean left ventricular ejection fraction was 45 ± 18%. Overall, 180 (23%) patients had isolated diastolic dysfunction, 234 (28%) tricuspid regurgitation, 121 (14%) isolated right HF and 100 (12%) mitral regurgitation. The most common diagnoses were hypertensive HF (281 [33%]), idiopathic dilated CMO (237 [28%]) and, surprisingly, right HF (225 [27%]). Black Africans had less ischemic CMO (adjusted OR 0.12, 95% CI 0.07 to 0.20) but more idiopathic and other causes of CMO (adjusted OR 4.80, 95% CI 2.57 to 8.93). Concurrent renal dysfunction, anemia and atrial fibrillation were found in 172 (25%), 72 (10%) and 53 (6.3%) cases, respectively.
These contemporary data highlight the multiple challenges of preventing and managing an increasing and complex burden of HF in urban Africa. In addition to tackling antecedent hypertension, a predominance of “young” women and a large component of right HF predicate the development of tailored therapeutic strategies. [Download]
Stewart S, Wilkinson D, Hansen C, Vaghela J, Mvungi R, McMurray J Sliwa K Predominance of Heart Failure in the Heart of Soweto Study Cohort: Challenges for Urban African Communities. Circulation 2008;118, 4 Dec.
Heart of Soweto Study Published
Preliminary findings from the Heart of Soweto Registry 2006 have been released. The Heart of Soweto study aims to improve our understanding of the characteristics and burden imposed by cardiovascular disease (CVD) in an African setting.
The team identified 4 162 cases of cardiovascular disease (1 593 newly diagnosed) in 2006. While the mean age was 54 years, almost a quarter were aged below 40 years. The five most common diagnoses overall were hypertension (54%), heart failure (47%), valvular heart disease or dysfunction (32%), coronary artery disease (15%) and diabetes (10%).
Prevalence of CVD risk factors was very high; only 13% had no risk factors while 47% of patients with hypertension were obese.
Overall, this data provided good evidence to show that the phenomenon of epidemiologic transition in Soweto, South Africa, has broadened the complexity and spectrum of heart disease in this community. We found multiple threats to the current and future heart health of Soweto from a high prevalence of modifiable risk factors for atherosclerotic disease, a combination of infectious and non-communicable forms of heart disease and late clinical presentation.
Heart of Soweto Study
The Heart of Soweto Study is a unique study of the emerging causes and consequences of cardiovascular disease in South Africa. Read more.
Acute Heart Failure Registry
A multicentre, prospective, observational, acute heart failure registry. Read more.
Peripartum Cardiomyopathy
Studies looking at the nature of peripartum cardiomyopathy in Africa. Read more.