Persisting burden and challenges of rheumatic heart disease

Abstract

Rheumatic heart disease (RHD) is the result of episodes of acute rheumatic fever with valvular (and other cardiac) damage caused by an abnormal immune response to group A streptococcal infections, usually during childhood and adolescence. As a result of improved living conditions and the introduction of penicillin, RHD was almost eradicated in the developed world by the 1980s. However, being a disease of poverty, its burden remains disproportionately high in the developing world, despite being a fundamentally preventable disease. Rheumatic heart disease generates relatively little attention from the medical and science communities, in contrast to other common infectious problems (such as malaria, HIV, tuberculosis), despite the major cardiovascular morbidity/mortality burden imposed by RHD. This relative neglect and paucity of funding have probably contributed to limited fundamental medical advances in this field for over 50 years. Given the importance of prevention before the onset of major valvular damage, the main challenges for RHD prevention are improving social circumstances, early diagnosis, and effective delivery of antibiotic prophylaxis. Early identification through ultrasound of silent, subclinical rheumatic valve lesions could provide an opportunity for early intervention. Simple echocardiographic diagnostic criteria and appropriately trained personnel can be valuable aids in large-scale public health efforts. In addition, a better understanding of the immunogenic determinants of the disease may provide potential routes to vaccine development and other novel therapies.

Acute Rheumatic Fever and Rheumatic Heart Disease: Highlighting the Role of Group A Streptococcus in the Global Burden of Cardiovascular Disease

“…Although such developments started in the early 1960s, progression towards a protective vaccine has been hampered by the widespread diversity of GAS strains (numerous emm types), cross-reactivity between streptococcal and host proteins, and lack of relevant animal models for studying the pathogenesis of RHD [ 81 ]. The three major types of vaccines are currently in development are those based on cell surface proteins, secreted proteins, and carbohydrates [ 82 ].…”

Analysis of rheumatic heart disease mortality in the Chinese population: A JoinPoint and age-period-cohort study

“…Global RHD morbidity and mortality declined in the 21st century, along with improvements in housing congestion and environmental pollution [3]. RHD morbidity and mortality rates in developed countries are almost 0, and RHD is currently concentrated in low-income countries and poverty groups of high-income countries [4,5]. In 2015, the three countries with the most deaths due to RHD were estimated to be India, China, and Pakistan [6].…”

Cardiovascular magnetic resonance characterization of rheumatic mitral stenosis: findings from three worldwide endemic zones

“…Rheumatic heart disease is the most common cause of mitral stenosis (MS), and remains a major cause of valve disease globally, occurring predominantly in developing countries [ 1 – 4 ]. Progressive MS leads to atrial arrhythmias, pulmonary hypertension, and heart failure, ultimately requiring percutaneous or surgical valve intervention [ 1 , 5 ].…”