Spectrum of heart disease and risk factors in a black urban population in South Africa (the heart of Soweto study): A cohort study

Sliwa, Karen, Wilkinson, David, Hansen, Craig, Ntyintyane, Lucas, Tibazarwa, Kemi, Becker, Anthony and Stewart, Simon (2008) Spectrum of heart disease and risk factors in a black urban population in South Africa (the heart of Soweto study): A cohort study. The Lancet, 371 9616: 915-922. doi:10.1016/S0140-6736(08)60417-1

Author Sliwa, Karen
Wilkinson, David
Hansen, Craig
Ntyintyane, Lucas
Tibazarwa, Kemi
Becker, Anthony
Stewart, Simon
Title Spectrum of heart disease and risk factors in a black urban population in South Africa (the heart of Soweto study): A cohort study
Journal name The Lancet   Check publisher's open access policy
ISSN 0140-6736
Publication date 2008
Year available 2008
Sub-type Article (original research)
DOI 10.1016/S0140-6736(08)60417-1
Volume 371
Issue 9616
Start page 915
End page 922
Total pages 8
Editor R. Horton
Place of publication United Kingdom
Publisher The Lancet Publishing Group
Collection year 2009
Language eng
Subject C1
110201 Cardiology (incl. Cardiovascular Diseases)
920103 Cardiovascular System and Diseases
11 Medical and Health Sciences
Formatted abstract
Background: The Heart of Soweto Study aims to increase our understanding of the characteristics and burden imposed by heart disease in an urban African community in probable epidemiological transition. We aimed to investigate the clinical range of disorders related to cardiovascular disease in patients presenting for the first time to a tertiary-care centre.

Methods: 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.
Keyword Active rheumatic catditis
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2009 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 166 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 24 Mar 2009, 18:19:20 EST by Helen Spindler on behalf of School of Medicine