The African Heartbeat

By: Merilynn Steenkamp, General Manager, Southern Africa Multi-Country Network at Roche Diagnostics

The heart is the centre of our human physiology. Quietly beating around 100,000 times a day, it sustains us by pumping nutrient and oxygen-rich blood through our circulatory systems, ensuring we are able to walk, talk, work – live. As we commemorate World Heart Day this September, we are reminded of the importance of heart health and caring for our most vital organ. However, cardiovascular diseases (CVDs) have become alarmingly prevalent across South Africa and the rest of the continent. So, what can we do to take better care of our hearts?^1,2

NCDs (non-communicable diseases) are expected to surpass infectious diseases in Africa within the current decade. In South Africa, they already have. According to Discovery, as of 2018, mortality rates from non-communicable diseases have already overtaken those of HIV/AIDS and tuberculosis combined. And, of all the NCDs, cardiovascular disease was highlighted as the highest contributor to death in the country.⁹ 

At the forefront of this phenomenon are common risk factors contributing to the growing burden of three major CVDs throughout the continent – hypertension, cardiomyopathies and atherosclerotic diseases, which have contributed to increased stroke and heart failure rates.¹ 

With a population of over one billion people, the African region is a major global contributor to the burden of cardiovascular disease. In 2019 alone, more than one million deaths were attributable to CVD in sub-Saharan Africa. This constituted 5.4% of all global CVD-related fatalities and 13% of all deaths in Africa, making CVD the second leading cause of death in Africa.³

To address the startling statistics, we need to look inward. Like the circulatory system that the heart powers, risk factors for CVDs are interconnected. High blood pressure (hypertension) is responsible for more than half of CVD-related deaths in Africa. Additionally, 24 million adults between the ages of 20 and 79 in Africa were living with diabetes in 2021.^3,4 

While that may sound unrelated to cardiovascular disease, it’s important to note that diabetes can lead to severe health complications, including chronic kidney disease, nerve damage and vision and hearing impairment. Another common – and potentially deadly – complication is CVD. Heart disease – particularly heart failure – is prevalent among people with Type 2 diabetes.⁵

Given the current context of the African burden of heart disease, several factors have brought us here. Rapid urbanisation and changes in lifestyle in Africa have led to an increase in sedentary habits, unhealthy diets and high stress levels. And it is known that increased salt consumption, low dietary potassium, obesity and physical inactivity can play an essential role in the occurrence of both hypertension and diabetes.^6,7

Beyond changing diets and lifestyles, many African countries face challenges, including widespread poverty and malnutrition and significant gaps in providing adequate healthcare services to their populations. Access to medical facilities, especially in rural areas, is limited, leading to delayed or insufficient diagnosis and treatment of CVD and other health conditions.⁸

Diagnosis of non-communicable diseases, including CVD – the first and arguably most crucial step, at least at the beginning of any patient’s healthcare journey – remains underfunded compared to communicable diseases like malaria, tuberculosis and HIV. 

The four A’s – Awareness, Action, Assessment and Access

Awareness begins at home

In closing, and to drive greater awareness for patients, it’s important to remember that lifestyle choices can influence cardiovascular health. As mentioned earlier, behavioural risk factors for heart disease and stroke can include an unhealthy diet and physical inactivity. Other severe risk factors include tobacco use and harmful use of alcohol.¹³ 

Incidentally, alcohol is the most abused substance in South Africa. Data shows that between 7.5% and 31.5% of South Africans have an alcohol problem or are at risk of developing one. The per capita consumption of alcohol in South Africa is 11 litres – the most in Africa.¹⁴

CVD warning signs to look out for include raised blood pressure, increased blood glucose, raised blood lipids and obesity. These “intermediate risk factors” can be assessed at most primary care facilities.¹³

Any heart-related illness is potentially dangerous. But we can take action to control our risk factors by making lifestyle changes and prioritising diagnosis. As motivational speaker, Josh Shipp said, “The choice does not belong to fate; it belongs to you.” Let’s build a cascade of better CVD management across Africa through awareness, action, assessment and driving access to diagnosis and care for every patient. 

References:

1. https://www.bhf.org.uk/informationsupport/how-a-healthy-heart-works#:~:text=The%20right%20ventricle%20pumps%20the,the%20rest%20of%20the%20body.
2. https://www.frontiersin.org/articles/10.3389/fcvm.2022.1008335/full 
3. https://world-heart-federation.org/where-we-work/africa/#:~:text=Africa%20is%20home%20to%20more,of%20all%20deaths%20in%20Africa. 
4. https://www.idf.org/our-network/regions-members/africa/diabetes-in-africa.html#:~:text=52%20million%20adults%20(20%2D79,and%20117%20million%20by%202045. 
5. https://www.cdc.gov/diabetes/managing/problems.html#:~:text=Common%20diabetes%20health%20complications%20include,how%20to%20improve%20overall%20health. 
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032113/ 
7. https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes 
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844097/ 
9. https://www.discovery.co.za/corporate/health-world-heart-day-29-september  
10. https://www.afro.who.int/news/low-awareness-and-control-hamper-hypertension-fight-africa 
11. https://patents.google.com/patent/US7608418B2/en 
12. https://medlineplus.gov/lab-tests/natriuretic-peptide-tests-bnp-nt-probnp/ 
13. https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1 
14. https://www.issup.net/knowledge-share/resources/2021-02/demand-alcohol-south-africa-during-national-lockdown#:~:text=Alcohol%20remains%20the%20primary%20substance,NDMP%2C%202019%3A29).