Acute Myocardial Infarction in Sub-Saharan Africa: The Need for Data

Abstract

BackgroundTrends in the prevalence of acute myocardial infarction in sub-Saharan Africa have not been well described, despite growing recognition of the increasing burden of cardiovascular disease in low- and middle-income countries. The aim of this systematic review was to describe the prevalence of acute myocardial infarction in sub-Saharan Africa.MethodsWe searched PubMed, EMBASE, Global Health Archive, CINAHL, and Web of Science, and conducted reference and citation analyses. Inclusion criteria were: observational studies, studies that reported incidence or prevalence of acute myocardial infarction, studies conducted in sub-Saharan Africa, and studies that defined acute myocardial infarction by EKG changes or elevation of cardiac biomarkers. Studies conducted prior to 1992 were excluded. Two independent reviewers analyzed titles and abstracts, full-texts, and references and citations. These reviewers also performed quality assessment and data extraction. Quality assessment was conducted with a validated scale for observational studies.FindingsOf 2292 records retrieved, seven studies met all inclusion criteria. These studies included a total of 92,378 participants from highly heterogeneous study populations in five different countries. Methodological quality assessment demonstrated scores ranging from 3 to 7 points (on an 8-point scale). Prevalence of acute myocardial infarction ranged from 0.1 to 10.4% among the included studies.InterpretationThere is insufficient population-based data describing the prevalence of acute myocardial infarction in sub-Saharan Africa. Well-designed registries and surveillance studies that capture the broad and diverse population with acute myocardial infarction in sub-Saharan Africa using common diagnostic criteria are critical in order to guide prevention and treatment strategies.RegistrationRegistered in International Prospective Register of Systematic Reviews (PROSPERO) Database #CRD42012003161.

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

“…With epidemiologic transition in the western world and other high-income countries, this increasing trend in mortality from IHD was noted to have begun as early as the 1920s and peaked in the late 1960s and 1970s and then started to decline in the 1980s, while mortality increased in other world regions before attenuating after the dawn of the 21st century [49,50]. Historically, very low prevalence, incidence and mortality from IHD have been observed in SSA compared to the HIC [51][52][53][54]. Back in the 1990s it was noted to account only for 6% of all CVDs in studied SSA regions [55].…”

“…In high-income countries, IHD is the most frequent cause of CVD death (16-19% of all deaths, 50-60% of CVD deaths) [2]. Earlier studies on IHD in SSA revealed the rarity of this disease from the 1940s to 1990s with rates of 0.3-3% on various study populations, though a steady rise was observed [51,52,54]. Among the world's poorest billion people (majority in SSA), IHD was found to account for only a relatively low 12% of the CVD DALYs, compared with 51% of DALYs in HIC [58].…”

Prevalence of cardiovascular risk factors among workers at a private tertiary center in Angola

“…However, the health system of most countries in the region do not have the preparedness to respond to this new reality 9–11. In addition, sub-Saharan Africa remains the region of the world where there is scarcity of data on CVD 8,12,13…”

Acute myocardial infarction in a resource-poor setting: a case report in Awka, Nigeria

“…The absence of high quality data relating to AMI in Sub-Saharan Africa, perhaps, makes this assertion speculative. 8,9 We found that our index patient belonged to the high socioeconomic group, has obesity, hypertension, and a sedentary life style, all of which have been reported as predisposing factors to ACS in Nigeria. 4 The diagnosis of AMI usually employs the classic World Health Organization criteria requiring that at least two of the following conditions be present: a) a history of ischemic-type chest discomfort, b) evolutionary changes in serially obtained ECG tracings, and c) a rise and fall in serum cardiac markers.…”