Circulation. 2005;112:3535
(Circulation. 2005;112:3535.)
© 2005 American Heart Association, Inc.
Issue Highlights
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RISK FACTORS ASSOCIATED WITH MYOCARDIAL INFARCTION IN AFRICA: THE INTERHEART AFRICA STUDY, by Steyn et al.
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The data presented by Steyn et al are from the INTERHEART case-control
study in 9 sub-Saharan African countries. This study shows,
for the first time, what the impact is of modifiable cardiovascular
disease (CVD) risk factors on acute myocardial infarctions (AMI).
Patients (n=578) were matched to 789 controls. Similar relationships
between common CVD risk factors and AMI were found as in the
overall INTERHEART study. Modeling of 5 risk factors (smoking,
self-reported diabetes and hypertension history, abdominal obesity,
and apoB:apoA1 ratio) provided a population-attributable risk
of 89.2% for AMI. Four of these risk factors can be determined
by taking a medical history and simply measuring the waist and
hip circumferences. Contrasting gradients found in socioeconomic
class, risk factors, and AMI risk when comparing ethnic subgroups
(black, colored, and European/other Africans) suggest different
stages of the epidemiological transition. This suggests that
AMI will increase in the future in sub-Saharan Africa unless
primordial prevention of CVD risk factors occurs, as well as
early diagnoses and effective treatment of those with CVD risk
factors. See p
3554.
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EPIDEMIOLOGY AND ETIOLOGY OF CARDIOMYOPATHY IN AFRICA, by Sliwa et al.
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Cardiomyopathy has been known to be endemic in sub-Saharan Africa
for nearly a century. The leading causes of heart failure in
sub-Saharan Africa are hypertension, valvular heart disease,
and cardiomyopathy. This is in contrast to other regions of
the world where heart failure is commonly caused by ischemic
heart disease. Sliwa and colleagues provide the most comprehensive
review to date of what is known about the causes and determinants
of heart muscle disease in Africa. They highlight the importance
of peripartum cardiomyopathy, which has a frequency as high
as 1 in 100 mothers giving birth in parts of Nigeria. Endomyocardial
fibrosis is a unique and debilitating form of tropical heart
muscle disease that may be found in up to 8% of the population
in parts of Mozambique. The authors call for renewed efforts
to identify the determinants of heart muscle disease through
population-based epidemiological research. See p
3577.
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HYPERTENSION IN SUB-SAHARAN AFRICAN POPULATIONS, by Opie and Seedat.
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Hypertension is a major problem in the black population of sub-Saharan
Africa. The prevalence varies from rural to urban populations.
There is a "second wave" epidemic of cardiovascular disease
(CVD) that is now flowing through developing countries and the
former socialist republics. There are genetic, endocrine, environmental,
and renal physiological factors that contribute to hypertension.
Sub-Saharan Africa is also burdened with infectious diseases
like AIDS, tuberculosis, and malaria, in addition to diseases
of lifestyle such as hypertension. The prevention of cardiovascular
diseases presents a challenge. Strategies to prevent the acquisition
or enhancement of CVD risk factors (primordial prevention) must
be combined to reverse or reduce risk factors, which include
changes in lifestyle and diet brought about by rapid urbanization.
The approach should be nonpharmacological, population based,
and lifestyle linked. This would obviate the biological and
economic costs of a pharmacological approach. There also is
a need to develop cost-effective methods for the diagnosis and
low-cost measures for all the risk factors of cardiovascular
disease. Although tertiary care is growing, the pattern should
be optimization of resources and the avoidance of high-cost,
low-yield technologies. See p
3562.
Visit http://www.circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Multislice Computed Tomography and Magnetic Resonance Imaging:
Complementary Use in Noninvasive Coronary Angiography. See p
e343.
Optical Coherence Tomography Findings at 5-Year Follow-Up After Coronary Stent Implantation. See p e345.
Subaortic Membrane in the Adult. See p e347.
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Correspondence
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See p
e348.
Related Articles:
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Risk Factors Associated With Myocardial Infarction in Africa: The INTERHEART Africa Study
- Krisela Steyn, Karen Sliwa, Steven Hawken, Patrick Commerford, Churchill Onen, Albertino Damasceno, Stephanie Ounpuu, Salim Yusuf for the INTERHEART Investigators in Africa
Circulation 2005 112: 3554-3561.
[Abstract]
[Full Text]
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Hypertension in Sub-Saharan African Populations
- Lionel H. Opie and Yackoob K. Seedat
Circulation 2005 112: 3562-3568.
[Abstract]
[Full Text]
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Epidemiology and Etiology of Cardiomyopathy in Africa
- Karen Sliwa, Albertino Damasceno, and Bongani M. Mayosi
Circulation 2005 112: 3577-3583.
[Abstract]
[Full Text]
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Multislice Computed Tomography and Magnetic Resonance Imaging: Complementary Use in Noninvasive Coronary Angiography
- Christoph Langer, Marcus Wiemer, Andreas Peterschröder, Krista Franzke, Hans Meyer, and Dieter Horstkotte
Circulation 2005 112: e343-e344.
[Full Text]
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Optical Coherence Tomography Findings at 5-Year Follow-Up After Coronary Stent Implantation
- E. Regar, H.M.M. van Beusekom, W.J. van der Giessen, and P.W. Serruys
Circulation 2005 112: e345-e346.
[Full Text]
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Subaortic Membrane in the Adult
- John Alfred Carr, Lissa Sugeng, Lynn Weinert, Valluvan Jeevanandam, and Roberto M. Lang
Circulation 2005 112: e347.
[Full Text]
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Letter Regarding Article by Jin et al, "Is Obesity a Risk Factor for Mortality in Coronary Artery Bypass Surgery?" • Response
- Usman Ahmad, Muhammad A. Javed, Saulat H. Fatimi, Ruyun Jin, Gary L. Grunkemeier, Anthony P. Furnary, and John R. Handy, Jr
Circulation 2005 112: e348.
[Full Text]
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