Pulmonary hypertension as seen in a rural area in sub-Saharan Africa: high prevalence, late clinical presentation and a high short-term mortality rate during follow up

Dzudie, Anastase; Dzekem, Bonaventure Suiru; Tchoumi, Cabral Tantchou; Aminde, Léopold Ndemnge; Mocumbi, Ana Olga; Abanda, Martin Hongieh; Thienemann, Friedrich; Kengne, André Pascal; Sliwa, Karen

doi:10.5830/cvja-2018-007

Cited by 14 publications

(22 citation statements)

References 18 publications

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“…At six-month follow-up, 21% of adults with follow-up data had died [108]. Similar findings were seen in the Cameroonian study that screened 2194 patients via echocardiograms, and observed a crude prevalence of PH of 15.6%, with mortality during six months of follow-up of 28% [109].…”

Section: Pulmonary Hypertensionsupporting

confidence: 79%

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

Yuyun

Sliwa

Kengne

et al. 2020

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245

211

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Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests that SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations. Highlights:-The burden of non-communicable diseases including cardiovascular diseases is rising in SSA.-Levels of hypertension diagnosis, treatment, and control are low at <40%, <35%, and 10-20%, respectively, and more than 40% of patients with diabetes are not aware of their diagnosis in SSA. -SSA has 23% of the world's prevalent rheumatic heart disease cases.-The leading causes of heart failure in SSA are hypertensive heart disease, cardiomyopathy, and rheumatic heart disease, with ischemic heart disease accounting for <10% of cases compared to >50% in high-income countries.

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Section: Pulmonary Hypertensionsupporting

confidence: 79%

“…Pulmonary hypertension (PH) in SSA is associated with very high mortality [108,109]. Community-based prevalence data for PH are lacking in SSA.…”

Section: Pulmonary Hypertensionmentioning

confidence: 99%

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

Yuyun

Sliwa

Kengne

et al. 2020

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245

211

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“…Pulmonary hypertension due to left heart disease (LHD) under the 1998 classification was referred to as pulmonary venous hypertension and classified under Group II PAH 41 , 42 . Based on underlying etiology, Group II PH patients were generally classified under two main categories i.e., those with end-stage heart failure, or those with mitral valve disease.…”

Section: Risk Factors That Complicate Hiv-phmentioning

confidence: 99%

Impact of human immunodeficiency virus on pulmonary vascular disease

Kumar

Mahajan

Salazar

et al. 2021

gcsp

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With the advent of anti-retroviral therapy, non-AIDS-related comorbidities have increased in people living with HIV. Among these comorbidities, pulmonary hypertension (PH) is one of the most common causes of morbidity and mortality. Although chronic HIV-1 infection is independently associated with the development of pulmonary arterial hypertension, PH in people living with HIV may also be the outcome of various co-morbidities commonly observed in these individuals including chronic obstructive pulmonary disease, left heart disease and co-infections. In addition, the association of these co-morbidities and other risk factors, such as illicit drug use, can exacerbate the development of pulmonary vascular disease. This review will focus on these complex interactions contributing to PH development and exacerbation in HIV patients. We also examine the interactions of HIV proteins, including Nef, Tat, and gp120 in the pulmonary vasculature and how these proteins alter the endothelial and smooth muscle function by transforming them into susceptible PH phenotype. The review also discusses the available infectious and non-infectious animal models to study HIV- associated PAH, highlighting the advantages and disadvantages of each model, along with their ability to mimic the clinical manifestations of HIV-PAH.

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“…At least six reports have looked at the aetiology of pulmonary heart disease in SSA [190][191][192][193][194][195].…”

Section: Pulmonary Heart Disease (Cor Pulmonale) and Pulmonary Hypertmentioning

confidence: 99%

Heart Failure in Sub-Saharan Africa

Adebiyi¹,

Sliwa‐Hähnle²

2019

Topics in Heart Failure Management

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Sub-Saharan Africa (SSA) is currently experiencing multiple burden of disease as a result of demographic and epidemiologic transition. This is occasioned rapid urbanization, unhealthy diets rich in fats and salt, western lifestyle and sedentary living. Heart failure (HF) has become a global public health issue. It is associated with high morbidity and mortality, frequent hospitalization and high economic cost. In SSA, HF is a disease of young and middle-aged adults with the attendant high disability-adjusted life years. This is unlike to the clinical profile and pattern of HF in high-income countries of North America, Western Europe and Japan where HF is a disease of the elderly. In addition, while ischaemic heart disease is the commonest aetiologic risk factor for HF in high income countries, HF in SSA is essentially non-ischaemic in origin. Hypertensive heart failure, dilated cardiomyopathy, rheumatic heart disease, pericardial diseases and HIV associated cardiomyopathy are the common risk factors. The chapter reviews the contemporary information on HF in SSA in terms of socio-demographic features, clinical characteristics, aetiological risk factors, management, prognosis and economic burden.

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Pulmonary hypertension as seen in a rural area in sub-Saharan Africa: high prevalence, late clinical presentation and a high short-term mortality rate during follow up

Cited by 14 publications

References 18 publications

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

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

Impact of human immunodeficiency virus on pulmonary vascular disease

Heart Failure in Sub-Saharan Africa

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