Cardiovascular Journal of Africa: Vol 32 No 5 (SEPTEMBER/OCTOBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 5, September/October 2021 AFRICA 241 in South African blacks. The opposite was true for the European or other African samples of the INTERHEART study. 21,22 Only 10.4% of those with a primary diagnosis of CVD were HIV infected. Hypertensive heart disease with heart failure and strokes were the predominant causes of hospital admission in the HIV-infected CVD cohort. Although HIV infection has emerged as an important risk factor for CAD, with a two-fold greater risk of acute coronary syndromes compared to HIV-uninfected individuals, 23 it is notable that in sub-Saharan Africa, heart failure has been the more dominant and important CVD manifestation. 24-26 Our study suggests that these observations have not changed and are generalisable to semi-rural regions of the country. The relatively low prevalence of CAD in both the CVD and HIV-CVD groups in our study despite the high prevalence of CAD risk factors suggests that there may still be an opportunity to interrupt the impending CAD epidemic with a more aggressive primary preventative strategy targeting lifestyle and behavioural changes, and risk-factor modification. 27,28 Screening and management of the traditional risk factors for CAD would go a long way in decreasing the morbidity and mortality associated with CAD in this patient population. Finally, up to 32.4% of the CVD patient population in this study was younger than 55 years, highlighting the far-reaching impact of CVD beyond ill health to potential loss of productivity (Fig. 5). Nelson Mandela Bay has high unemployment rates and poverty and the role of these upstream modifiable factors on CVD is unknown. Additionally, community screening for and treating hypertension could have a tremendous impact on reducing CVD mortality rates. Therefore, community screening and treating modifiable risk factors for CVD instead of dealing with target-organ damage is a viable strategy for reducing CVD mortality in this particular population. Study limitations Our study has several limitations. First, this is a single-centre retrospective study, therefore not generalisable to the broad South African community. Second, we did not have clinical and echocardiographic data to classify heart failure in a contemporary manner. We also did not have data on other cardiovascular risk factors such as smoking history or dyslipidaemia. We did not offer screening testing for dyslipidaemia or diabetes mellitus and therefore missed the opportunity to diagnose and treat undiagnosed diabetes mellitus or dyslipidaemia. Conclusion In this study, carried out in a semi-rural South African district hospital, we found that CVD were responsible for a third of hospital admissions, and a third of CVD patients were younger than 55 years of age. 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