CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
104
AFRICA
Editorial
A snapshot of cardiovascular diseases in Africa in the
new millennium
The ageing of populations observed in many settings around
the world extends to sub-Saharan Africa (SSA), where life
expectancy at birth has increased by about 18 years between
1950 and 2010.
1
It has been estimated that ageing of African
populations will accelerate further in the coming decades, such
that the gap in life expectancy with the world average will drop
from 20 years in 2010, to only about 10 years by 2050. Lessons
learned from other parts of the world suggest that changes in
the age structure of populations with increasing proportions of
elderly people, which is also known as ‘demographic transition’,
is usually paralleled by changes in health profiles, which have
been characterised as ‘epidemiological transitions’.
2
Based on the Western models of epidemiological transitions,
chronic non-communicable diseases (NCDs) replace infectious
diseases as the major cause of death and disability during the
demographic transition. Several lines of evidence suggest that
chronic NCDs are gaining ground in Africa; however, this
against a background of highly prevalent infectious diseases,
some of which have chronic patterns, which are still contributing
a very significant proportion of deaths on the continent. These
competing disease profiles have been detrimental for chronic
diseases; resulting in knowledge generation and translation,
policy formulation and implementation, and health service
development for chronic NCDs to severely lag behind those for
infectious diseases in Africa.
A major challenge in appraising the true magnitude of chronic
NCDs and on-going efforts to prevent and control them in
Africa has been the lack of locally relevant scientific evidence.
3
There is, however, the suggestion that the situation is rapidly
improving, with the growing number of high-quality scientific
publications that are emerging on NCDs in Africa.
4
This was
already apparent in December 2005, when the leading world
journal of cardiovascular diseases,
Circulation,
undertook to
publish a dedicated series of scientific articles on cardiovascular
diseases (the leading chronic NCDs) in sub-Saharan Africa.
5
This series of nine scientific articles plus an editorial had the
particularity of been driven essentially by African researchers
who were able to rigorously build on personal experience and
published data at the time, and provide a comprehensive and
representative picture of cardiovascular disease in SSA.
The success of the articles in the
Circulation
series,
5
as
measured by the large number of citations attached to each of
them, attests to the influential role the initiative of
Circulation
has played within less than 10 years in shaping the landscape of
cardiovascular diseases in SSA. However, this series was mostly
based on evidence from the last century, while more evidence
is emerging in the context of improved access to care for major
infectious diseases such as HIV infection and tuberculosis,
and increasing awareness on chronic NCDs in Africa.
6
Regular
updates are therefore needed to carry the wave initiated by
Circulation
in 2005 across time.
5
It is exactly what a group of
dedicated scientists, including some who were already involved
in the 2005 initiative, have successfully achieved.
In a series titled ‘Cardiology inAfrica 2013 Update’ published
online on 15 May 2013 in
Heart
, a leading international
cardiovascular journal from the
British Medical
Journals
’ group,
a comprehensive overview is provided on recent developments
on cardiovascular diseases in Africa, and strategies to improve
the prevention and control discussed by leading scientists with
established research experience on CVD in Africa. The series has
at least two distinctive features. One is the period covered by the
included studies, which does not extend beyond the last 10 years,
therefore allowing the series to project an unclouded picture of
CVD in Africa in the early 21st century.
The second feature of the series is the nearly equal coverage
given to diseases of modern lifestyle which are often the major
focus when approaching CVD from a global perspective,
and the neglected CVDs, which are rather rare elsewhere, yet
remain a major challenge in Africa. For instance, in one of the
articles dedicated to endomyocardial fibrosis (EMF), a condition
described for the first time in Uganda in 1938,
7
Drs Mocumbi
and Falase
8
provide findings confirming that three-quarters of a
century from the first description, EMF has remained a frequent
but neglected CVD in Africa. As a consequence, little is known
on the mechanisms and treatment of the disease, which is still
associated with a poor prognosis.
Recent advances on acute heart failure and cardiomyopathies
are covered in another article in the series by Sliwa and Mayosi.
9
Reliable and robust evidence on acute heart failure have recently
emerged from a multicentre, cross-continental study, showing
that 90% of cases of heart failure in Africa can be attributed
to hypertension, rheumatic heart disease and cardiomyopathy,
which is at variance with findings from the West where heart
failure is largely due to coronary heart disease.
10
Furthermore,
heart failure in Africa is a disease of young people, with a
similar high early mortality rate as found elsewhere, and the
uptake of evidence-based therapies for heart failure by healthcare
providers in Africa is still below optimal.
The epidemiology of cardiomyopathy, a leading cause of
heart failure in Africa, has been refined in recent studies in
Africa. Findings from those studies are informing the design and
implementation of further investigations into the pathogenesis
and management of cardiomyopathies on the continent.
9
Cardiovascular diseases in specific populations within Africa
are covered in two articles in the series. In their article on
CVD in people with HIV, Syed and Sani
11
shed light on the
contrast in the spectrum of CVD among people with HIV in
the West and those in Africa. While improving survival among
people with HIV infection on antiretroviral therapy in the West
has been associated with premature occurrence of CVD of
