Cardiovascular disease in sub-Saharan Africa

Abstract

Globally, non-communicable diseases (NCDs) are the leading cause of death, accounting for nearly three-quarters of all deaths, led by cardiovascular diseases (CVD)-with ischaemic heart disease (IHD) and stroke being the leading cause of global cardiovascular (CV) mortality and a major cause of CV morbidity and disability. (1) CVD is an important cause of premature mortality and rising healthcare costs in all regions of the world; and is driven by rapidly evolving cardio-metabolic, behavioural, psychological, environmental, and social risk factors and determinants of health. (2) Consistent, comparable, and systematic analysis of trends and patterns in CVD are essential to guide public policy and provide benchmarks for decision-makers. Worldwide, prevalent cases of total CVD nearly doubled from 271 million in 1990 to 523 million in 2019, and the number of CVD deaths steadily increased from 12.1 million in 1990, reaching 18.6 million in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million to 34.4 million over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million DALYs, 9.14 million deaths in the year 2019, and 197 million prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million DALYs, 6.55 million deaths in the year 2019, and 101 million prevalent cases of stroke in 2019. (1) Sub-Saharan Africa (SSA) is unique epidemiologically. Unlike in every other region in the world, NCDs are the second most common cause of death in SSA, accounting for 2.6 million deaths (about 35% of all deaths in SSA). (3) In fact, in SSA, the leading cause of mortality is the composite of infections, maternal, neonatal, and nutritional diseases. Current predictions are that by the year 2030, NCDs will account for more than half of all deaths in SSA, and will be the leading cause of mortality, similar to other parts of the world. (4) While age-adjusted CVD mortality rates in SSA are much lower compared to high-income countries, the absolute number of CVD deaths has increased by more than 50% in the past 3 decades in SSA. (5) HEART FAILURE Although there have been no population-based epidemiological studies of heart failure in Africa, there have been numerous hospital-based studies that give important insights into the incidence and prevalence of HF in SSA. (6-12) A recent meta-analysis of heart failure studies in SSA depicted