International Health / Individuals living in low-to-middle income countries
Professor Karen Sliwa
There is increasing recognition that the diverse peoples of sub-Saharan Africa, as with many communities in low-to-middle income countries, face a number of paradoxical challenges arising from economic development and urbanisation . Whist these promise a reduction in the diseases of poverty (predominantly malnutrition and infectious disease) they will undoubtedly come at a price with a parallel rise in non-communicable forms of cardiovascular disease (CVD). A recent report from the Heart of Soweto Study, suggested that the urban, predominantly African community of more than 1 million people, stands at the crossroads between traditional/communicable forms of heart disease (including rheumatic heart disease [RHD]  and the dilated cardiomyopathies ) and non-communicable forms of heart disease linked to epidemiological transition . The most profound finding of this study is that women predominate and that de novo cases of often advanced forms of heart disease from both sexes are far younger than that seen in high income countries. Although cases of coronary artery disease (CAD) are on the rise , it is hypertensive heart failure (HF) that represent the most common form of non-communicable heart disease in Soweto , reflecting high levels of hypertension in urban communities in sub-Saharan Africa as a whole . Secondary prevention programs designed to not only detect those with established and often disabling forms of heart disease and other forms of CVD (including ischaemic and non ischaemic forms of stroke ) but prevent disease progression and a premature death are an obvious priority; whilst acknowledging the challenges of undertaking research in a resource-poor environment .
Building on a rich tradition of developing innovative health services for individuals with chronic heart disease, the Centre of Research Excellence to Reduce Inequality in Heart Disease will undertake the following research activities:
- Assist the Hatter Institute for Cardiovascular Research in Africa to coordinate a range of research programs throughout sub-Saharan Africa (http://african-heart.org/).
- Provide high level supervision and assistance to African researchers and clinicians.
- Undertake pragmatic primary and secondary prevention trials designed to lessen the impact of epidemiological transition and the rise of non-communicable forms of heart disease in vulnerable urban communities.
List of Projects
HEART OF SOWETO
HEART OF AFRICA (a broad range of studies are being undertaken via this program of research coordinated by the Hatter Institute in Cape Town, South Africa.)
- Sliwa K, Wilkinson D, Hansen C, Ntyintyane L, Tibazarwa K, Becker A, Stewart S. Spectrum of heart disease and risk factors in a black urban population in South Africa (the Heart of Soweto Study): a cohort study. Lancet. 2008;371(9616):915-22.
- Sliwa K, Carrington M, Mayosi BM, Zigiriadis E, Mvungi R, Stewart S. Incidence and characteristics of newly diagnosed rheumatic heart disease in urban African adults: insights from the heart of Soweto study. Eur Heart J. 2010;31(6):719-27.
- Stewart S, Wilkinson D, Hansen C, Vaghela V, Mvungi R, McMurray J, Sliwa K. Predominance of heart failure in the Heart of Soweto Study cohort: emerging challenges for urban African communities. Circulation. 2008;118(23):2360-7.
- Stewart S, Carrington M, Pretorius S, Methusi P, Sliwa K. Standing at the crossroads between new and historically prevalent heart disease: effects of migration and socio-economic factors in the Heart of Soweto cohort study. Eur Heart J. 2011;32(4):492-9.
- Becker AC, Jacobson B, Singh S, Sliwa K, Stewart S, Libhaber E, Essop MR. The thrombotic profile of treatment-naive HIV-positive Black South Africans with acute coronary syndromes. Clin Appl Thromb Hemost. 2011;17(3):264-72.
- Stewart S, Libhaber E, Carrington MJ, Damasceno A, Abbasi H, Hansen C, Wilkinson D, Sliwa K. The clinical consequences and challenges of hypertension in urban-dwelling black Africans: Insights from the Heart of Soweto Study. Int J Cardiol 2011; 146(1):22-27.
- Stewart S, Carrington MJ, Pretorius S, Ogah OS, Blauwet L, Antras-Ferry J, Sliwa K. Elevated risk factors but low burden of heart disease in urban African primary care patients: A fundamental role for primary prevention. Int J Cardiol. 2012;158(2):205-10.
- Damasceno A, Gomes J, Azevedo A, Carrilho C, Lobo V, Lopes H, Madede T, Pravinrai P, Silva-Matos C, Jalla S, Stewart S, Lunet N. An epidemiological study of stroke hospitalizations in Maputo, Mozambique: a high burden of disease in a resource-poor country. Stroke. 2010;41(11):2463-9.
- Stewart S, Sliwa K. Preventing CVD in resource-poor areas: perspectives from the 'real-world'. Nat Rev Cardiol. 2009;6(7):489-92.