CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
AFRICA
135
research agenda to accurately determine the current burden
and fully characterise and quantify the factors underlying this
epidemic in Africa.
The Cardiovascular Working Group of H3Africa therefore
aims to explore this rising burden of CVDs using novel genomic
and epidemiological tools to inform appropriate interventions
for the continent. We seek to comprehensively characterise
the genomic, sociocultural, economic and behavioural risk
factors leading to the development of clinical risk factors (e.g.
hypertension and diabetes) and sub-clinical disease (e.g. cardiac
and cerebral vascular structural changes), which in turn result
in multiple organ damage
7,16
(e.g. stroke, and kidney and heart
failure).
To begin this work, the H3Africa Cardiovascular Working
Group will hold an inaugural workshop on 30 May 2014 in Cape
Town, South Africa, in conjunction with the fourth H3Africa
consortium meeting (
-
h3africa-consortium-meeting). The specific working group
objectives are (1) to review the current burden of CVDs and their
risk factors in Africa, identifying knowledge gaps; (2) to provide
the research and surveillance pillar of the integrated CVDs
quadrangle (the remaining three pillars are prevention, acute care
and rehabilitation) aimed at reducing the rising burden of CVDs;
(3) to develop, nurture and strengthen synergistic symbiotic
collaboration among H3Africa teams exploring CVDs and their
risk factors using novel genomic and epidemiological tools;
(4) to enhance our understanding of the genetic underpinnings
of the common major CVDs in Africa and across the globe;
and (5) to facilitate an appreciation of the pathophysiological
interrelationships between cardiometabolic diseases and certain
infectious/inflammatory diseases (e.g. rheumatic heart disease,
HIV), the heart, brain and kidneys.
7,16-21
It is anticipated that
refinement and harmonisation of phenotypic characteristics,
consideration of environmental factors, and the recruitment
of large numbers of well-characterised patients with diverse
CVDs across the continent will result in a better understanding
of the links between phenotype and genotype in this extremely
important group of diseases.
In understanding these complex interrelationships throughout
the course of life, we will study important pathways, including
endothelial dysfunction, indices of microvascular damage (e.g.
albuminuria), oxidative stress, inflammatory processes, as well
as endocrine and paracrine influences.
22-24
Furthermore, we will
explore how these indices inform the development of risk-
prediction models and integrated surveillance systems, as well
as tailored (responsive) systems and individual-level preventive
and therapeutic interventions within and beyond the continent.
The H3Africa Cardiovascular Working Group welcomes the
active participation of all interested scientists in the inaugural
workshop on 30 May 2014 in Cape Town.
We thank the members of the H3Africa consortium and its international
expert panel of advisors for building this remarkable resource. The H3Africa
consortium is funded by the National Institutes of Health and the Wellcome
Trust. The workshop is supported by the National Institute of Diabetes
and Digestive and Kidney Diseases, the National Heart, Lung and Blood
Institute, the National Institute of Neurological Disorders and Stroke, the
National Human Genome Research Institute, and the National Institutes of
Health office of AIDS Research.
The Wellcome Trust
/> is a global charitable
foundation dedicated to achieving extraordinary improvements in human
and animal health. It supports the brightest minds in biomedical research
and the medical humanities. The Trust’s breadth of support includes public
engagement, education and the application of research to improve health. It
is independent of both political and commercial interests. See
.
h3africa.org/consortium/projects for a complete list of grants.
The views expressed in this article are those of the authors and do not
necessarily represent the views of the National Institutes of Health or the US
Department of Health and Human Services.
References
1.
World Health Organisation. Assessing national capacity for the preven-
tion and control of non-communicable diseases: report of the 2010
global survey. Geneva: World Health Organisation; 2012.
2.
Leeder S, Raymond S, Greenberg H, Liu H, Esson K.
A Race
against Time: The Challenge of Cardiovascular Disease in Developing
Countries.
NewYork: Trustees of Columbia University, 2004.
3.
Lozano R, Naghavi M, Foreman K,
et al
. Global and regional mortal-
ity from 235 causes of death for 20 age groups in 1990 and 2010:
a systematic analysis for the Global Burden of Disease Study 2010.
Lancet
2012;
380
(9859): 2095–2128.
4.
Murray CJ, Vos T, Lozano R,
et al.
Disability-adjusted life years
(DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a
systematic analysis for the Global Burden of Disease Study 2010.
Lancet
2012;
380
(9859): 2197–2223.
5.
World Health Organization.
Preventing Chronic Diseases: a Vital
Investment.
Geneva: World Health Organization, 2005.
6.
Mensah GA. Epidemiology of stroke and high blood pressure in Africa.
Heart
2008;
94
(6): 697–705.
7.
Mensah GA. Descriptive epidemiology of cardiovascular risk factors
and diabetes in sub-Saharan Africa.
Prog Cardiovasc Dis
2013;
56
(3):
240–250.
8.
Feigin VL, Forouzanfar MH, Krishnamurthi R,
et al
. Global and region-
al burden of stroke during 1990–2010: findings from the Global Burden
of Disease Study 2010.
Lancet
2014;
383
(9913): 245–254.
9.
Krishnamurthi R, Moran A, Forouzanfar MH, Bennet D, Mensah GA,
et al
. The global burden of haemorrhagic stroke – a summary of find-
ings from the Global Burden of Diseases, Injuries and Risk Factors
2010 Study.
Global Heart
2014;
9
(1): 101–106.
10. Owolabi MO. Taming the burgeoning stroke epidemic in Africa: stroke
quadrangle to the rescue.
West Ind Med J
2011;
60
(4): 412–421.
11. Mayosi BM, Flisher AJ, Lalloo UG, Sitas F, Tollman SM, Bradshaw
D. The burden of non-communicable diseases in South Africa.
Lancet
2009;
374
(9693): 934–947.
12. Tollman SM, Kahn K, Sartorius B, Collinson MA, Clark SJ, Garenne
ML. Implications of mortality transition for primary health care in
rural South Africa: a population-based surveillance study.
Lancet
2008;
372
(9642): 893–901.
13. Kim AS, Johnston SC. Global variation in the relative burden of stroke
and ischemic heart disease.
Circulation
2011;
124
(3): 314–323.
14. Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular
diseases: part I: general considerations, the epidemiologic transition,
risk factors, and impact of urbanization.
Circulation
2001;
104
(22):
2746–2753.
15. Mensah GA. Introduction: progress in cardiovascular diseases and
diabetes in Africa.
Prog Cardiovasc Dis
2013;
56
(3): 232–233.
16. Lim SS, Vos T, Flaxman AD,
et al.
A comparative risk assessment of
burden of disease and injury attributable to 67 risk factors and risk
