Cardiovascular Journal of Africa: Vol 26 No 2 Supplement (March/April 2015)

22 / 64

S20 AFRICA
CVJAFRICA • Volume 26, No 2, H3Africa Supplement, March/April 2015
prevention, i.e. networks and systems of learning communities
that continually seek wellness and innovate to improve health?
What if we were able to realise precision and personalised
medicine to prevent and pre-empt the burden of cardiovascular,
lung and blood diseases? What if we could eliminate stroke and
cognitive impairment in persons living with SCD by providing
access to the benefits of chronic blood transfusions,15 or better
still, what if we could find ways to up-regulate modifier genes
or identify new vasculopathy targets that could completely
transform the landscape of cerebrovascular outcomes in SCD
patients?
While we seek novel approaches, including systems science,
new tools and platforms and genomics, we would be remiss if
we forgot implementation research, which is paramount for
advancing adherence to best practices for health promotion: diets
rich in fruits and vegetables, physical activity, tobacco avoidance
or smoking cessation; and the prevention and treatment of
cardinal risk factors such as high blood pressure, dyslipidaemia
and diabetes, which are central to HLBS conditions. In this
regard, can we imagine the hypothetical scenario wherein
we optimally disseminate and implement evidence-based ‘best
buy’ approaches, with the resultant improvement in the social
wellbeing and productivity of many around the world?
Conclusion
The importance of disease prevention and treatment, as well
as the social significance of science, call for collaborative
partnerships in response to adverse trends in HLBS conditions
and related disorders, both at the domestic and global fronts.
It is gratifying to observe the evolution of such a collaborative
network under the umbrella of the H3Africa initiative. The SSA
region as well as the USA will benefit immensely from such
partnership models in an effort to rise to the emerging challenges
posed by the growth of HLBS diseases and risk factors.
More importantly, vertical integration of efforts across
continents may prove to be very helpful and synergistic as we
seek to discover new targets or transformative approaches for
maximising population-level impact and consequently reduce
health inequities. For instance, lessons learned from novel
approaches for improving outcomes among SCD patients in
SSA may be very helpful for SCD patients in the domestic USA.
Therefore there are benefits that can come full circle when we
address life’s most persistent and urgent question, as eloquently
posed by Dr Martin Luther King Jr: ‘What are we doing for
others?’ This is the era to create a collective future, because the
concept of collective destinies could not be more palpable than
it is now.
The views expressed in this article are those of the authors and do not neces-
sarily represent the views of the National Heart, Lung, and Blood Institute,
National Institutes of Health, or the US Department of Health and Human
Services.
References
1. The NHLBI Mission Statement.
Accessed December 26, 2014.
2. Mensah GA, Kiley J, Mockrin SC, Lauer M, Hoots WK, Patel YC,
et al. National Heart, Lung, and Blood Institute Strategic Visioning:
Setting an agenda together for the NHLBI of 2025. Am J Public Health
2015: e1–e4.
3. Sampson UK, Mensah GA, Foroufanzar MH, Roth G, Naghavi M,
Ezzati M, et al. The burden of sickle cell disease: a comparison of global
and sub-Saharan African estimates of disability adjusted life years.
H3Africa Cardiovascular Workshop, Stellenbosch, South Africa, 2014.
4. Piel FB, Hay SI, Gupta S, Weatherall DJ, Williams TN. Global burden
of sickle cell anaemia in children under five, 2010–2050: modelling based
on demographics, excess mortality, and interventions. PLoS Med 2013;
10: e1001484.
5. Sampson UK, Mensah GA, Foroufanzar MH, Roth G, Naghavi M,
Ezzati M, et al. The burden of high body mass index from 1990 to 2010:
a comparison of sub-Saharan Africa and developed regions. H3Africa
Cardiovascular Workshop, Stellenbosch, South Africa, 2014.
6. National Healthcare Disparities Report (2013). U.S. Department
of Health and Human Services, Agency for Healthcare Research
and Quality.
. December 26, 2014.
7. Christakis NA, Fowler JH. The spread of obesity in a large social
network over 32 years. N Engl J Med 2007; 357: 370–379.
8. Barabasi AL. Network medicine – from obesity to the “diseasome”. N
Engl J Med 2007; 357: 404–407.
9. Miranda ML, Ferranti J, Strauss B, Neelon B, Califf RM. Geographic
health information systems: a platform to support the ‘triple aim’.
Health Affairs 2013; 32: 1608–1615.
10. Wu GD, Chen J, Hoffmann C, Bittinger K, Chen YY, Keilbaugh SA, et
al. Linking long-term dietary patterns with gut microbial enterotypes.
Science 2011; 334: 105–108.
11. Tang WH, Wang Z, Levison BS, Koeth RA, Britt EB, Fu X, et al .
Intestinal microbial metabolism of phosphatidylcholine and cardiovas-
cular risk. N Engl J Med 2013; 368: 1575–1584.
12. Wang D, Xia M, Yan X, Li D, Wang L, Xu Y, et al. Gut microbiota
metabolism of anthocyanin promotes reverse cholesterol transport in
mice via repressing miRNA-10b. Circ Res 2012; 111: 967–981.
13. Thomson R, Genovese G, Canon C, Kovacsics D, Higgins MK,
Carrington M, et al. Evolution of the primate trypanolytic factor
APOL1. Proc Natl Acad Sci USA 2014; 111: E2130–2139.
14. Genovese G, Friedman DJ, Ross MD, Lecordier L, Uzureau P,
Freedman BI, et al. Association of trypanolytic ApoL1 variants with
kidney disease in African Americans. Science 2010; 329: 841–845.
15. Verduzco LA, Nathan DG. Sickle cell disease and stroke. Blood 2009;
114: 5117–5125.