A hidden menace: Cardiovascular disease in South Africa and the costs of an inadequate policy response

Abstract

A hidden menace: Cardiovascular disease in South Africa and the costs of an inadequate policy response and unhealthy diets. Even in rural SA, associated diffusion of urban behaviours is fostering the CVD epidemic. The United Nations projects that the percentage of population above 60 years will more than double between 1999 and 2050 in SA, with the burden due to CVD predicted to become the prime contributor to total morbidity and mortality in the over 50-year age group.(4) However, CVD is taking its toll even amongst the younger age groups, with deaths projected to increase by over 40% in the 35-to 64-year age group by 2030. This is further complicated by the growing number of HIV survivors, now estimated at 5.8% of the population older than 50 years. (5,6) This poses several challenges regarding the management of this emerging epidemic in the face of persisting undernutrition and Assuming a 4% rate of inflation, and a higher prevalence of CVD, the overall costs for CVD in 2010 would be more than double that 20 years ago. rIsk fActors In south AfrIcAThe major risk factors namely high blood pressure, tobacco use, high cholesterol, obesity, physical inactivity and unhealthy diets are increasingly prevalent in Africa, both in urban and rural settings.The national prevalence of hypertension in sub-Saharan African countries (SSA) ranges from about 4% to 10%, with SA at the upperend of this spectrum. The prevalence of hypertension amongst males and females in one rural Mpumalanga district was 44%and 42% respectively, (12) a figure much higher than that reported for other rural areas in SSA. Several disease specific guidelines for hypertension, chronic diseases of lifestyle (CDL) and for type 2 diabetes mellitus have been developed. (17,18) These guidelines provide information on the management and control and include interventions that have been shown to be cost-effective in middle and lower-income countries.However, available evidence suggests that primary prevention and management of common cardiac conditions is limited even with these guidelines "in place".Prioritisation of interventions for the primary prevention of chronic diseases is minimal. For example, the guideline on primary prevention of CDL lists a variety of interventions for management. Whilst focus on CVD has been minimal, the revised South African guideline for managing ischaemic stroke and transient ischaemic attack is a notable step. (24) This guideline puts forward a protocol for management that considers both the current epidemiological context and the strength of evidence of interventions for stroke care. The comprehensive plan that spans across all aspects of care including primary prevention, acute management, secondary prevention and rehabilitation, offers hope for mitigating the burden of disease due to stroke. ApproAchEs to prEVEntIonTwo approaches are conventionally advocated for CVD prevention. Population-wide approaches targeting the entire population and addressing the causes rather than the consequences; and those that target individual...

Care and management of a double burden of chronic diseases: Experiences of patients and perceptions of their healthcare providers

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Collaborative care for the detection and management of depression among adults with hypertension in South Africa: study protocol for the PRIME-SA randomised controlled trial

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