CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 AFRICA 131 From the Editor’s Desk Cardiovascular disease (CVD)-related admissions are on the increase in Africa. Amadi and colleagues report (page 140) that in a study carried out in a tertiary hospital over a 16-year period in Lagos, Nigeria, that CVD admissions are not only common in Nigeria, but there was also a temporal exponential increase in both the admission and death rates, most likely reflecting the epidemiological transition in that country. Notably, the median age of the patients was 56.6 (46.0–68.0) years. As has been noted previously, the transition seems to be associated with presentation of the conditions at a younger age. Naidoo and colleagues, in a study of young black Africans living in urban South Africa (page 157), have shown a high prevalence of elevated blood pressure (EBP), particularly in males, and that an overwhelming proportion who had EBP at 22 years continued to have EBP six years later. In addition, EBP in females was associated with a history of gestational hypertension and injectable contraceptive use, while in males EBP was associated with haematuria. Albuminuria, a surrogate marker for vascular and renal target-organ damage, was associated with EBP with profound implications for premature cardiovascular and all-cause mortality, while also providing opportunities for lifestyle and therapeutic interventions to mitigate risk. Specialist electrophysiological services are not widely available in Africa and it is pleasing to see that they appear to be increasing and usage is being documented. In this, the first reported case series from Africa, Vezi and co-authors document their experience with His bundle pacing (HBP) for a variety of indications (page 190). They stress the importance of HBP in resource-limited countries. It is important to recognise that these excellent results may be influenced by operator experience. In young patients without atherosclerotic coronary artery disease, the aetiology of sudden cardiac death (SCD) has been described in Europe and North America. However, there are important regional variations and there are limited data on the aetiology and outcome of SCD in South Africa. Mkoko and colleagues (page 150) sought to determine the profile and outcomes of young patients treated with implantable cardioverter defibrillators (ICDs) at a South African tertiary hospital. In this single-centre study from South Africa, arrhythmogenic right ventricular cardiomyopathy and repaired congenital heart disease were the leading causes of SCD in patients younger than 35 years treated with secondary-prevention ICDs. Primaryprevention ICDs were frequently implanted for idiopathic dilated cardiomyopathy. Appropriately, the authors point out the limitations of their study. Pat Commerford Editor-in-Chief Professor PJ Commerford
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