There is very little community data on incidence and prevalence of CVD in Africa. Most data are derived from health facilities and cross-sectional surveys. With an expected increase in life expectancy, these conditions will become more prevalent in Africans. Hypertension related disorders such as stroke are important causes of ill-health and pre-mature death in Africans. In fact, some communities in sub-Saharan Africa have relatively high rates of hypertension. There is little data on community based stroke incidence or prevalence in Africans.
A Tanzanian study suggests that stroke death rates are higher in Africa than in Europe. Sub-Saharan Africa has the highest burden of rheumatic fever (RF) in the world with almost a million children suffering from the condition. In October, 2005, a group of health professionals and advocates met in South Africa and issued a declaration, the Drakensberg Declaration, to prevent and control Rheumatic Fever/rheumatic heart disease on the continent. In this regard, the Pan African Society of Cardiology (PASCAR) has teamed up with the World Heart Federation to implement A.S.A.P.(Awareness, Surveillance, Advocacy and Prevention) programme to prevent and control RF/RHD in three demonstration sites in Egypt, Ghana and South Africa. It is hoped that the programme will be scaled up in due course to include other African countries.
Idiopathic cardiomyopathy remains a common cause of ill-health in Africans. Peripartum cardiomyopathy is not uncommon in African pregnant women. Though nutritional factors have been implicated, its aetiopathogenesis remains largely unknown. Recent studies have not shown any relation to viral or HIV infection. There is some evidence, however, to suggest abnormal signalling of the JAK STAT pathway with increased oxidative stress and increased apoptosis.
There is very little data on coronary artery disease (CAD) in Africans. CAD is not yet the commonest cause of mortality in adult Africans. This provides a window of opportunity with regards to prevention. In the InterHeart Study, CAD occurred earlier in Africans compared to other ethnic groups. There is limited capacity and resources for cardiology and cardiac surgery in Africa. Outside Northern Africa, only South Africa, Ghana, Sudan and Kenya to a limited extent, perform regular open heart surgery. Most of the cases requiring surgery are rheumatic in origin. There is great potential for primordial, primary and secondary prevention of CVD in Africa. To complement the prevention strategies, Regional Centres of Excellence to provide cost effective care of patients needing surgery was advocated.