Some puzzling situations in the onset, occurrence and future of coronary heart disease in developed and developing populations, particularly such in sub-Saharan Africa

Abstract

Coronary heart disease (CHD) was rare in developed populations until the early 1900s; this prevailed even among the small segments who were prosperous and who, in measure, had most of the currently recognised risk factors. However, in the 1930s, with improved circumstances from general rises in socio-economic state, there were major increases in the occurrence and mortality rate from the disease, the latter reaching a third of the total mortality in some countries, as in the United Kingdom (UK). Puzzlingly, the inter-population diversity of the increases in CHD has been such that there are as much as five fold differences in CHD mortality rates, as, for example, between Poland and Spain. Within recent years, with appropriate treatments, the mortality rate has halved in some countries, again, as in the UK. However, the incidence rate of the disease has diminished little or hardly at all. Risk factors include a familial component and, nutritionally, over-eating, a high fat intake, relatively low intakes of plant foods, especially of vegetables and fruit and, non-nutritionally, smoking, excessive alcohol consumption and a low level of everyday physical activity. On the one hand, known risk factors, broadly, are considered to be capable of explaining only about half of the variation in the occurrence of the disease. Even at present, known risk factors far from fully explain the epidemiological differences in mortality rates. Yet, on the other hand, there is abundant evidence that in population groups, among whom risk factors are low or have been reduced, CHD incidence and mortality rates are lower. Notwithstanding this knowledge, broadly, there is very little interest in the general public in taking avoiding measures. As to the situation in developing populations, in sub-Saharan Africa, in urban Africans, as in Johannesburg, South Africa, despite considerable westernisation of life style and with rises in risk factors, CHD remains of very low occurrence, the situation thereby resembling, historically, its relatively slow emergence in developed populations. In most eastern countries, mortality rates remain relatively low, as in Russia and Japan. However, in major contrast, in India, rates have risen considerably in urban dwellers. Indeed, in Indian immigrants, as in those in the UK, their rate actually exceeds that in the country's white population. In brief, much remains to be explained in the epidemiology of the disease.

Evaluation of a school-based nutrition and physical activity programme for Grade 4 learners in the Western Cape province

“…1 The growing prevalence of noncommunicable chronic diseases is evident in South Africa as well. [2][3][4] In 2000, physical inactivity was estimated to be the ninth leading cause of deaths in South African adults. The majority of these deaths were attributed to ischaemic heart disease.…”

Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries

“…1 From the 1930s to the 1950s, the rate of cardiovascular disease increased in high-income countries, but during this period, the rates were low in middle-and low-income countries. 2,3 Since the mid-1970s, the rate of death from cardiovascular diseases has declined markedly in several high-income countries, owing to reductions in risk factors and improved management of cardiovascular disease. 4 By contrast, the incidence of cardiovascular disease has been increasing in some low-income and middle-income countries, 5,6 with 80% of the global burden estimated to occur in these countries.…”

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.…”