Cardiovascular Journal of Africa: Vol 24 No 2 (March 2013)

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 2, March 2013 34 AFRICA
Review Article
Epidemiology of ischaemic heart disease in sub-Saharan
Africa
CHURCHILL LUKWIYA ONEN
Abstract
Background: The epidemiology of ischaemic heart disease
(IHD) in sub-Saharan Africa (SSA) remains largely enig-
matic. Major obstacles to our understanding of the condition
include lack of reliable health statistics, particularly cause-
specific mortality data, inadequate diagnostic capabilities,
shortage of physicians and cardiologists, and misguided
opinions.
Methods: This review of the epidemiology of ischaemic heart
disease in sub-Saharan Africa involved a systematic biblio-
graphic MEDLINE search of published data on IHD in SSA
over the past century. Search words included epidemiology,
ischaemic (coronary) heart disease, myocardial infarction,
cardiovascular risk factors and sub-Saharan Africa. Selected
data are presented on the prevalence of cardiovascular risk
factors and mortality from ischaemic heart disease from
different countries representing the main regions of the
continent.
Results:Although IHD in SSA remains relatively uncommon,
its prevalence is predicted to rise in the next two decades due
to the rising prevalence of risk factors, especially hyperten-
sion, diabetes, overweight and obesity, physical inactivity,
increased tobacco use and dyslipidaemia. It is estimated that
age-standardised mortality rates for IHD will rise by 27%
in African men and 25% in women by 2015, and by 70 and
74%, respectively by 2030.
Conclusion: Ischaemic heart disease remains relatively
uncommon in SSA, despite an increasing prevalence of risk
factors, but its incidence is rising. The pace and direction of
economic development, rates of urbanisation, and changes in
life expectancy resulting from the impact of pre-transitional
diseases and violence will be major determinants of the IHD
epidemic in SSA. The best window of opportunity for preven-
tion of the emerging epidemic of ischaemic heart disease in
sub-Saharan Africa is now.
Keywords: epidemiology, ischaemic heart disease, sub-Saharan
Africa
Submitted 23/1/12, accepted 16/10/12
Cardiovasc J Afr 2013; 24: 34–42
DOI: 10.5830/CVJA-2012-071
‘a riddle wrapped in a mystery inside an enigma’
1 October, 1939
Sir Winston Churchill, British orator, author and Prime Minister
(1874–1965)
Over a century ago, Sir Winston Churchill, a renowned British
statesman and leader during the Second World War (WWII),
made a celebrated visit to Uganda, where he was so moved as to
describe it as ‘the Pearl of Africa’. Sir Winston, referring to the
quality of intelligence gathered by Western allies during WWII,
called Russia a ‘riddle wrapped in a mystery inside an enigma’.
While the same phrase could be used today to describe the
epidemiology of ischaemic heart disease (IHD) in sub-Saharan
Africa (SSA) because of many puzzles and lingering myths,
what is enigmatic is the contempt with which the potential
threat of IHD has been treated at various levels of health sectors,
governments and international agencies. A recent change in
posture by World Health Organisation (WHO) Regional Office
for Africa, with greater focus on non-communicable disease
(NCD), and the United Nations high-level meeting on NCD
prevention and control in New York on 19–20 September 2011
are good indicators of the recognition of the importance of
NCDs and the rapidly unfolding epidemiological landscape
catalysed by the birth of conjoined twins, infectious diseases and
non-communicable diseases.
The 30th anniversary of the Pan-African Society of Cardiology
(PASCAR) conference along with the Third All-Africa
Conference on Heart Disease, Diabetes and Stroke took place
at Munyonyo Speke Resort in Kampala on the shores of Lake
Victoria in May 2011. The warmth of the land, the gentle tropical
rain showers interspersed with bright sunshine, and above all, the
friendliness of Ugandans must have pervaded the hearts of most
foreign delegates to the conference.
This review article will focus on some of the obstacles to our
understanding of IHD in SSA. A synopsis of cardiovascular risk
factors and their role in IHD in SSA, and selected mortality data
on IHD from various countries across the continent are presented
in this article. A plea for urgent and concerted action to avert the
impending epidemic of IHD in SSA is made.
Obstacles to our understanding of IHD in SSA
Major obstacles to our understanding of IHD in SSA include
lack of reliable statistics on health, life expectancy and disease
incidence, and the absence of cause-specific mortality data.
This is confounded by lack of diagnostic capabilities in most
of SSA, emanating from a shortage of physicians, particularly
cardiologists, and lack of appropriate investigations, such as
Centre for Chronic Diseases, Gaborone, Botswana
CHURCHILL LUKWIYA ONEN, MD FRCP,