CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
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AFRICA
improving the cardiovascular health of the people of Africa over
the last three decades, despite a difficult socio-economic and
political context. The secretary-general also expanded on the
challenges that the present and future generations face to carry
on the charge of furthering the health of Africans.
President Macky Sall expressed his gratitude to the organisers
of the meeting for having solicited him and said he was proud to
be in the ‘heart of heart specialists’. He was fully convinced and
would advocate everywhere that Africa must build protections
against heart disease so as to stop hypertension and other
cardiac risk factors from becoming established epidemics on the
continent. He welcomed all the PASCAR delegates to Senegal,
a welcome worthy of the legendary Senegalese ‘teranga’ (the
Wolof word for hospitality is ‘teranga’ and it is so identified
with the pride of Senegal that the national football team is known
as the Lions of Teranga). About 700 delegates from English-,
French- and Portuguese-speaking African countries and also
from Europe and the USA attended the Dakar meeting.
Workshops
Five workshops ocurred simultaneously on Wednesday
morning and were very well attended. The workshop on
interventional cardiology was hosted by the Pan-African Course
on Interventional Cardiology (PAFCIC), (represented by Prof
Habib Gamra, Tunisia), PASCAR (represented by Prof Bongani
Mayosi, South Africa) and the American College of Cardiology/
Association of Black Cardiologists (represented by Prof Ola
Akinboboye, USA).
This workshop highlighted the growing incidence of ischaemic
heart disease among Africans and the current difficulties in
management, with very few acute cases benefiting from lytic
therapy or primary coronary interventions. Some African
countries such as Kenya have achieved significant progress in
terms of acquiring invasive cardiac catheterisation laboratories,
mainly in the private sector. Establishing a collaborative training
and research programme between PAFCIC, PASCAR and ACC/
ABC will help increase the state of readiness of cardiovascular
practitioners to cope with the rising burden of disease.
The echocardiography, rhythmology and paramedical
workshops were very practical (hands-on training) sessions and
were well attended by delegates.
Scientific sessions
Obesity, diabetes and hypertension
Dr Andre Pascal Kengne, a distinguished Cameroon researcher
from the Medical Research Council, South Africa stated that
evidence has been accumulating on the importance of the rising
burden of diabetes mellitus and obesity on the African continent.
This has been at an increasingly higher pace than previously
expected and than elsewhere in the world. He showed important
differences in prevalence across countries and between rural and
urban regions.
2,3
Prof Said Norou Diop (Senegal) stated that the care for diabetes
largely remains suboptimal in most countries, which are not
adequately prepared to face the prevention and control of diabetes.
The costs of caring for the condition pose a tremendous challenge
to most local economies. Prof Jean Jacques Monsuez (France)
described the higher prevalence of CVD among diabetic patients.
Prof Terrence Forester (Jamaica) showed that nutrition in early
life influences the pathogenesis and prevention of cardiometabolic
disease in Africans. The panel concluded that research is needed
to contextualise the existing evidence for diabetes screening
and prevention in African settings, and to better characterise
the interaction of genetic and environmental factors on the
occurrence of diabetes and obesity on the continent.
The rising incidence of obesity and diabetes inAfrica parallels
the incidence of hypertension. Prof Moustapha Saar (Senegal)
presented hypertension as the dominant risk factor for CVD in
Africa, with a prevalence ranging from 20 to 35% of the adult
population, and this prevalence is anticipated to rise dramatically.
Dr Daniel Lemogoum (Cameroon) said hypertension is currently
poorly diagnosed, poorly treated and poorly controlled in
Africa, exposing the African continent to the burden of serious
adverse outcomes. He concluded that an updated but simplified
Pan-African guideline for management of this disease is needed.
4
Prof Jean Jacques Blacher (France) presented the current
French and also European guidelines for treatment of
hypertension. He insisted on the use of the triad combination of a
diuretic, an inhibitor of the renin angiotensin aldosterone system
and a calcium channel blocker whenever necessary to control
resistant hypertension. The panel concluded that decisive actions
are needed by African governments and policymakers to stop the
negative health effects of uncontrolled hypertension.
Stroke
Prof Mouhamadou Mansour Ndiaye (Senegal) gave an overview
of the epidemiology and diagnosis of stroke. According to
him, the burden of cerebrovascular disease manifests mainly as
stroke caused by high blood pressure, and is now an established
important cause of premature disability, morbidity and mortality
in most regions of the continent.
Prof Ibrahima Diakhaté (Senegal) advocated for the increased
availability of non-invasive imaging of stroke in most African
centres. Prof Albertino Damasceno (Mozambique) presented
the management strategies of stroke, which need to be effected
through concerted implementation of several public health
measures, primary and secondary prevention policies and cost-
effective treatment, running in parallel with and underpinned by
coordinated research initiatives.
5
Heart failure and cardiomyopathies
The results of THESUS-HF, the African prospective registry
of heart failure, which were published in 2012, were presented
by Prof Albertino Damasceno (Mozambique).
6
This study
has provided several key insights into the epidemiology and
prognosis of acute heart failure and cardiomyopathy on the
continent, with hypertension emerging as the leading risk factor
for heart failure, highlighting once more the need to place the
treatment and control of hypertension in a central role for the
global improvement of cardiovascular health in Africans.
Prof Abdoul Kane (Senegal) gave a comprehensive lecture
on heart failure with preserved ejection fraction, with emphasis
on new approaches to diagnosing the disease. Prof Karen Sliwa
(South Africa) demonstrated that peripartum cardiomyopathy
(PPCM) is one of the prevalent aetiologies of heart failure
in women and is associated with adverse outcomes. She
stated that the discovery of potential mechanistic pathways for
