The new face of heart disease

Heart disease might no longer be the sole domain of the middle-aged white male. ELMIEN WOLVAARDT spoke to Prof Anthony MBewu about the possible epidemic facing our country.

Most of us think of cardiovascular disease as affecting only white, middle-aged males.

But is that still the case? Nearly all the research done so far has been on white South Africans - very little is actually known about the prevalence of heart disease amongst our other population groups.

In order to redress this imbalance, the MRC is funding a pilot heart study, based on which the National Institutes of Health (NIH) will decide whether or not to fund the most comprehensive coronary heart disease study every done in South Africa.

"We suspect that socio-economic changes and increased levels of urbanization since 1994 have significantly altered the diets of previously rural people, as well as increasing their access to alcohol and cigarettes. People close to cities also tend to do more sedentary work than their counterparts in rural areas.

"All of these factors combine to increase their risk of cardiovascular disase," says Prof Anthony MBewu, cardiologist and Research Director at the MRC.

Ironically, doctors suspect that the decrease seen in heart disease among white males over the last couple of decades is due precisely to its public image as a white male disease. Awareness campaigns around the issue, based on extensive research on the Afrikaner population in particular, encouraged people to give up smoking and reduce their fat intake. The unfortunate side effect, however, was the branding of heart disease as a white, male disease.

"The danger is that, because of existing perceptions about heart disease, health professionals don't expect to see it in their black patients, which means they are less likely to diagnose it in time," says Prof MBewu.

"We simply do not know enough about the prevalence and risk factors of heart disease among the non-white population groups in South Africa. What we do know, is that doctors at state hospitals are seeing an increasing number of black patients with heart disease.

"Accurate information is needed if we are to design effective prevention and intervention programmes that can mirror the success of the campaigns aimed at white males."

The need for a national South African heart study has become obvious to Prof MBewu and his colleagues, and some progress has already been made in that regard.

Prof Herman Taylor, lead investigator of the Jackson Heart Study in Mississippi (see sidebar), was here in January to help develop a protocol for the study.

After the completion of the pilot study, which will determine whether the research is feasible, a protocol and funding request will be submitted National Institutes of Health (NIH) in the United States.

"The study has a twin purpose: firstly, to see how much heart disease there is out there, particularly among black South Africans, and secondly, to find out what the risk factors and determinants of that heart disease are," Prof MBewu said.

He will be the lead investigator of the study, which will follow a multidisciplinary approach

involving laboratory scientists, clinicians in hospitals, public health researchers and health policy researchers. The three proposed referral centres for the study will be Medunsa in Limpopo Province, Chris Hani Baragwanath Hospital in Gauteng, and Albert Luthuli Hospital in Natal. Researchers hope to recruit a community of patients that they can follow for a long period of time, as is being done in the Jackson Heart Study.

Prof Herman Taylor, Chief Investigator of the Jackson Heart Study (right)
and Dr David Williams, a member of the study's Scientific Directions Committee.

"Our research hypothesis is that we need to intervene within the next five years if we want to prevent a heart disease epidemic, such as that seen amongst African Americans, occurring in South Africa by 2015," says Prof MBewu.