Heart disease in Soweto: facing a triple threat

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• 作者：Harvey D White ; Anthony J Dalby
• 关键词：Ionic conductivity ; Perchlorates ; Reorientation of anions ; Paddle-wheel mechanism
• 刊名：The Lancet
• 出版年：2008
• 出版时间：15 March 2008-21 March 2008
• 年：2008
• 卷：371
• 期：9616
• 页码：876-877
• 全文大小：45 K

文摘

From Jan 1 to Dec 31, 2006, we recorded data for 4162 patients with confirmed cases of cardiovascular disease (1593 newly diagnosed and 2569 previously diagnosed and under treatment) who attended the cardiology unit at the Chris Hani Baragwanath Hospital in Soweto, South Africa. We developed a prospectively designed registry and gathered detailed clinical data relating to the presentation, investigations, and treatment of all 1593 patients with newly diagnosed cardiovascular disease.

Findings

Most patients were black Africans (n=1359 [85 % ]), and the study population contained more women (n=939 [59 % ]) than men. Women were slightly younger than were men (mean 53 [SD 16] years vs 55 [15] years; p=0·031), with 399 (25 % ) patients younger than 40 years. Heart failure was the most common primary diagnosis (704 cases, 44 % of total). Moderate to severe systolic dysfunction was evident in 415 (53 % ) of 844 identified cases of heart failure, 577 (68 % ) of which were attributable to dilated cardiomyopathy or hypertensive heart disease, or both. Black Africans were more likely to be diagnosed with heart failure than were the rest of the cohort (739 [54 % ] vs 105 [45 % ]; odds ratio [OR] 1·46, 95 % CI 1·11–1·94; p=0·009) but were less likely to be diagnosed with coronary artery disease (77 [6 % ] vs 88 [38 % ]; OR 0·10, 0·07–0·14; p<0·0001). Prevalence of cardiovascular risk factors was very high, with 897 (56 % ) patients diagnosed with hypertension (190 [44 % ] of whom were also obese). Only 209 (13 % ) patients had no identifiable risk factors, whereas 933 (59 % ) had several risk factors.

Interpretation

We noted many threats to the present and future cardiac health of Soweto, including a high prevalence of modifiable risk factors for atherosclerotic disease and a combination of infectious and non-communicable forms of heart disease, with late clinical presentations. Overall, our findings provide strong evidence that epidemiological transition in Soweto, South Africa has broadened the complexity and spectrum of heart disease in this community. This registry will enable continued monitoring of the range of heart disease.

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mg src=""/scidirimg/btn_xclose.gif"" alt=""Close"" title=""Close"" onmouseover=""javascript:this.src='/scidirimg/btn_xclose_hov.gif';"" onmouseout=""javascript:this.src='/scidirimg/btn_xclose.gif';""> mg border=0 src=""/scidirimg/jrn_nsub.gif"" alt=""You are not entitled to access the full text of this document"" title=""You are not entitled to access the full text of this document"" width=12 height=14""> m/science?_ob=ArticleURL&_udi=B6T16-4RPVHXF-2&_user=10&_coverDate=01 % 2F30 % 2F2008&_rdoc=1&_fmt=high&_orig=article&_cdi=4882&_sort=v&_docanchor=&view=c&_ct=16273&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=6e3aa2383045260db142798ba5388a7d"">A time bomb of cardiovascular risk factors in South Africa: Results from the Heart of Soweto Study “Heart Awareness Days” International Journal of Cardiology, In Press, Corrected Proof, Available online 30 January 2008 Kemi Tibazarwa, Lucas Ntyintyane, Karen Sliwa, Trevor Gerntholtz, Melinda Carrington, David Wilkinson, Simon Stewart Abstract mlktScroll""> Background There is strong anecdotal evidence that many urban communities in Sub-Saharan Africa are in epidemiologic transition with the subsequent emergence of more affluent causes of heart disease. However, data to describe the risk factor profile of affected communities is limited. Methods During 9 community screening days undertaken in the predominantly Black African community of Soweto, South Africa (population 1 to 1.5 million) in 2006–2007, we examined the cardiovascular risk factor profile of volunteers. Screening comprised a combination of self-reported history and a clinical assessment that included calculation of body mass index (BMI), blood pressure and random blood glucose and total cholesterol levels. Results In total, we screened a total of 1691 subjects (representing almost 0.2 % of the total population). The majority (99 % ) were Black African, there were more women (65 % ) than men and the mean age was 46 ± 14 years. Overall, 78 % of subjects were found to have ≥ 1 major risk factor for heart disease. By far the most prevalent risk factor overall was obesity (43 % ) with significantly more obese women than men (23 % versus 55 % : OR 1.76 95 % CI 1.62 to 1.91: p < 0.001). A further 33 % of subjects had high blood pressures (systolic or diastolic) and 13 % an elevated (non-fasting) total blood cholesterol level: no statistically significant differences between the sexes were found. There was a positive correlation between increasing BMI and other risk factors including elevated systolic (r2 = 0.046, p < 0.001) and diastolic blood pressure (r2 = 0.032, p < 0.001) with overweight subjects three times more likely to have concurrent hypercholesterolemia (OR 3.3, 95 % CI 2.1 to 5.3: p < 0.01). Conclusions These unique pilot data strongly suggest a high prevalence of related risk factors for heart disease in this urban black African population in epidemiologic transition. Further research is needed to confirm our findings and to determine their true causes and potential consequences. m/science?_ob=MImg&_imagekey=B6T16-4RPVHXF-2-7&_cdi=4882&_user=10&_orig=article&_coverDate=01 % 2F30 % 2F2008&_sk=999999999&view=c&wchp=dGLzVlz-zSkWA&md5=3766c738d82d410e8b9084bc43fc7e19&ie=/sdarticle.pdf"">mg name=""pdf"" style=""vertical-align:absmiddle;"" border=""0"" src=""http://www.sciencedirect.com/scidirimg/icon_pdf.gif"" alt=""""> Purchase PDF (705 K)