Background: cardiovascular disease is a global but neglected health issue
Cardiovascular diseases (CVDs), particularly those related to atherosclerosis and hypertension, are often perceived to be problems unique to the “developed world” of high-income countries. However, in many regions of the world, physically active lives have been replaced with inactive ones and people are consuming calories out of proportion to their daily needs. Modern/commercial ways of processing food promote obesity and may be important contributors to the development of “fatty plaque” in our blood vessels, resulting in deadly and disabling conditions such as stroke and heart attack.
In 2009, the World Health Organization re-emphasised the importance of chronic (non-communicable) diseases, in particular cardiovascular disease, as a neglected global health issue.
Leading the way: The Heart of Soweto Study and Soweto Cardiovascular Research Unit
Like many other parts of the globe, Africa is experiencing a transition towards greater wealth and prosperity. It has been estimated that within the next 20 years, 1.3 million people per year will be affected by heart disease in Africa. Heart disease has the potential to not only cause disabling symptoms, but result in premature death in those who would have otherwise survived to a relatively old age. Fortunately, many of the causes of heart disease (e.g. high blood pressure, obesity, diabetes and smoking) are either treatable or completely preventable.
However, Africa is under threat from other forms of heart disease due to unique conditions e.g. cardiomyopathy, an often deadly cardiac condition affecting African women after childbirth. It is vitally important that the full range of “common” and African-specific forms of heart disease are fully researched on this continent with the intention of developing effective treatments and healthcare programmes (i.e. from prevention to cure).It is within this context that the Soweto Cardiovascular Research Unit, under the leadership of Prof. Karen Sliwa, has, over the past few years, focused their research activities on cardiac conditions specific to Africa. This led to the establishment of the Heart of Soweto Study (HOS), where she and her collaborators managed to document aetiology, presentation, and management of conditions such as peripartum cardiomyopathy. Worldwide awareness was generated via her articles in high-impact journals and in the process, Prof Sliwa highlighted the enormous potential of studying heart disease in Soweto.
Established close to the city of Johannesburg, South Africa, 100 years ago, Soweto now represents one of the largest urban areas on the African continent. As in many other developing regions, populations move from rural to urban areas and in the process, change their way of living. Home to more than 1 million people, the population of Soweto has benefited from improved economic conditions and public health advances in recent years. Unfortunately, the “cost” of these improved conditions has been an increase in the number of individuals seeking medical care from the Cardiology Unit at the Baragwanath Hospital for heart disease or its common precursors.
The prevention and management of CVD and other chronic diseases of lifestyle need to be executed in a multidisciplinary effort with all the necessary healthcare workers involved, and then implemented at primary and secondary level. This should include specific risk factor profiling and trajectory of CVD in these resource-poor communities in epidemiologic transition, building on the HOS data and experiences.