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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 3, May/June 2021
156
AFRICA
Review Article
National prevalence of coronary heart disease and
stroke in South Africa from 1990–2017: a systematic
review and meta-analysis
Nada Abdelatif, Nasheeta Peer, Samuel OM Manda
Abstract
Background:
South Africa is experiencing an increasing
burden of cardiovascular diseases, including coronary heart
disease (CHD) and stroke. We aimed to obtain overall nation-
al prevalence estimates of CHD and stroke in South Africa.
Methods:
Studies conducted in South Africa were system-
atically reviewed from PubMed, Scopus and Web of Science
from January 1990 to July 2017. Random-effects meta-anal-
yses were conducted on the selected studies to determine the
overall prevalence of CHD and stroke.
Results:
Out of 2 466 studies, only 12 covering 75 140 partici-
pants reported the national prevalence of CHD and stroke.
All 12 studies estimated the national prevalence of both
diseases based on self-reported disease status. The overall
national prevalence was 1.29 (95% CI = 0.83; 1.75) and 4.29
(95% CI = 3.13; 5.45) for CHD and stroke, respectively. Only
one study reported incidence rates so we did not perform any
meta-analysis of incidence rates.
Conclusions:
There are very few studies on national preva-
lence of CHD and stroke in South Africa. Well-structured
registries for CHD and stroke are required to accurately iden-
tify the disease burden and enable adequate resources to be
allocated for the implementation of appropriate prevention
and management programmes.
Keywords:
coronary heart disease, stroke, meta-analysis, South
Africa
Submitted 16/10/19, accepted 2/10/20
Published online 26/3/21
Cardiovasc J Afr
2021;
32
: 156–160
www.cvja.co.zaDOI: 10.5830/CVJA-2020-045
Cardiovascular diseases (CVDs) account for 31% of global
deaths annually, with more than 80% due to coronary heart
disease (CHD) and stroke;
1
this amounts to 15 million deaths.
2
The CVD burden in low- and middle-income countries (LMICs),
including those in sub-Saharan Africa (SSA), is more severe
and occurs at a younger age, that is, in the working population.
This has serious economic and social consequences, not only for
the individual but also for their families and the economy. The
higher mortality burden in younger individuals in their prime
in LMICs is likely attributable to inadequate prevention and
management because prevention is not a priority, and effective
treatments are not widely available.
3
In order to address this gap in suboptimal prevention and
management, it is vital to have accurate data on the incidence
and prevalence of CHD and stroke to adequately manage these
conditions. Given that risk factors for CVDs are known and
can largely be modified and controlled, 80% of premature heart
attacks and strokes could be preventable.
4
This is particularly
important for SSA, where there was a 38% increase in CHD from
2000 to 2016, and stroke rose by 25% within the same period,
with a projected increase of 21 and 82% by 2030 for CHD and
stroke, respectively.
2
This places a great strain on a region that is
already highly burdened with HIV and other infections, violent
death, and perinatal and maternal diseases.
5
This is especially true for South Africa where CHD and stroke
are among the top 10 leading causes of mortality alongside the
high mortality rate attributable to HIV and tuberculosis.
6,7
It is
estimated that five and 10 people have a stroke and heart attack,
respectively, every hour, 10 of which result in death. Although
mortality data are available for CHD and stroke, evidence on
the incidence and prevalence of these conditions nationally by
gender, urban–rural residence and population group is lacking
in South Africa.
9,10
The available research that focuses on CHD and stroke in the
country
11-15
has not been systematically evaluated and described
in a manner that summarises the evidence thus far. Accurate and
up-to-date information on the incidence and prevalence of these
CVDs is crucial to enable appropriate and adequate allocation of
healthcare resources for the prevention andmanagement of CHD
Biostatistics Research Unit, South African Medical
Research Council, Durban, South Africa
Nada Abdelatif, MSc,
nada.abdelatif@mrc.ac.zaNon-communicable Diseases Research Unit, South African
Medical Research Council, Durban; Department of Medicine,
University of Cape Town, Cape Town, South Africa
Nasheeta Peer, MB ChB, MBA, MPH, PhD
Biostatistics Research Unit, South African Medical
Research Council, Pretoria; Department of Statistics,
University of Pretoria, Pretoria; School of Mathematics,
Statistics and Computer Science, University of KwaZulu-
Natal, Pietermaritzburg, South Africa
Samuel OM Manda, MSc, PhD