"Heart of Soweto" study reveals high rate of heart conditions in the Soweto population

However, in many regions of the world, physically active lives have been replaced with inactive ones with people consuming calories out of proportion to their daily needs. Modern and commercial ways of processing food also promote obesity and the development of diabetes, and may be important contributors to the development of more affluent forms of disease.

In 2005 the World Health Organization re-emphasised the importance of chronic (non-communicable) diseases, in particular cardiovascular disease as a neglected global health issue.

The ‘Heart of Soweto Study'

It is within this context that the Soweto Cardiovascular Research Unit, part of the Wits Cardiology Unit at the Chris Hani Baragwanath Hospital, under the leadership of Wits Professor Karen Sliwa-Hanhle and her team, has over the past few years focused their research activities on heart conditions almost specific for Africa.

They initiated the unique Heart of Soweto Study that monitors the “heart health” of the 1-million strong Soweto population via: 1) an advanced clinical registry of all patients attending the hospital and 2) community-based surveillance programmes.

“We selected Soweto as it now represents one of the largest urban areas on the African continent,” says Sliwa-Hanhle. “As in many other developing regions, populations move from rural to urban areas and in that process change their way of living. Soweto is home to more than 1-million people and the population has benefited from improved economic conditions and public health advances in recent years. Unfortunately, the “cost” of these improved conditions has seen an increase in the number of individuals seeking medical care from the Wits Cardiology Unit at the Baragwanath Hospital for heart disease or its common precursors.”

Results of the Heart of Soweto Study were published on the 14th March in The Lancet, in collaboration with the Baker Heart Research Institute in Melbourne, Australia (Prof. Simon Stewart) and the University of Queensland (Prof. David Wilkinson).

The failing heart health of Africa

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. Says Sliwa-Hanhle: “Heart disease has the potential to not only cause disabling symptoms but also to result in premature death in those who would have otherwise survived to a relatively old age. Fortunately, many of the causes of heart disease (eg. high blood pressure, obesity, diabetes and smoking) are either treatable or completely preventable.”

She adds: “Africa also faces a threat from other forms of heart disease due to unique conditions like peripartum 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 diseases is fully researched on this continent with the intention of developing effective treatments and health care programmes.”

Results of the study published in The Lancet on 14 March 2008

“In 2006, we identified 4162 cases of cardiovascular disease, of which 1593 were newly diagnosed, presenting to the Cardiology Unit at Baragwanath Hospital,” says Sliwa-Hanhle. “The major findings from the largest and most comprehensive study of heart disease in Africa indicated that most patients had multiple risk factors commonly associated with affluent heart disease in the developed world. For example, many women were obese and more than one in two patients had a history of high blood pressure. Among the 1593 newly diagnosed cases, heart failure was the most common primary diagnosis (44% of cases) and many patients presented with advanced forms of heart disease.”

She adds: “These findings suggest that this phenomenon is likely due to combinations of lack of awareness of this condition, paucity and quality of primary care facilities and that there are now multiple threats to the current and future “heart 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.”

“The overall challenge is now how to increase scarce health resources to the people in developing countries. One of the commonly recurring themes in studies of health in Africa is the lack of reliable statistics. The results of this registry, emanating from one of the largest urban populations of Black Africans, goes a long way to correcting this deficit for heart disease in Soweto.”

This ongoing study will be able to provide important insights into the prevalence of heart disease in the Soweto community, which is the first step to mitigate the modern global epidemic of cardiovascular disease.

“Reports of changes over time via future reports will be able to document the velocity and nature of the continuing epidemiological transition towards more affluent heart disease,” says Sliwa-Hahnle. “Changes in risk factors will be documented and hopefully improvements in mortality and morbidity from various forms of heart disease will occur by instituting the preventive strategies and management programmes that are suggested by this important work.”