RISK FACTORS ASSOCIATED WITH MYOCARDIAL INFARCTION IN AFRICA: THE INTERHEART AFRICA STUDY, by Steyn et al.
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.
EPIDEMIOLOGY AND ETIOLOGY OF CARDIOMYOPATHY IN AFRICA, by Sliwa et al.
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.
HYPERTENSION IN SUB-SAHARAN AFRICAN POPULATIONS, by Opie and Seedat.
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.
Images in Cardiovascular Medicine
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.
See p e348.