About Us
(From left to right) Richard Ndlovu (Bayer), Prof Karen Sliwa, Tanja Steenekamp (Bayer) and Louis Kuneka at the entrance to the Soweto Cardiovascular Research Unit
About Us
The Soweto Cardiovascular Research Heart Unit (Socru) was set up in January 2006 to co-ordinate research into cardiovascular disease in Soweto, South Africa, and to promote research collaboration in this area.
Socru is a University of the Witwatersrand recognised research unit. “The unit’s mission is to do research in particular in cardiovascular diseases that are common in Southern Africa because little research is done in that area,” says the unit’s director, Professor Karen Sliwa. “Conditions that are specific to Southern Africa need to be studied in our local environment. Little interest exists in other parts of the world to engage in research in particular diseases such as peripartum Cardiomyopathy, since pathogeneses and management of such diseases is of lesser importance to the western world.”
The unit is based at Chris Hani Baragwanath Hospital in Soweto, south of Johannesburg. It works hand-in-hand with the Cardiac Department at the hospital, researching heart disease in patients that visit the hospital’s Cardiac Clinic. The clinic sees approximately 9000 patients per year.
Socru is funded primarily by the University of the Witwatersrand and receives projects grants from the South African Medical Research Council, the Circulatory Disorder Research Fund, and also from business, including pharmaceutical companies Bayer, which sponsors this website, Pfizer, and pacemaker manufacturer Medtronic. Tiger Brands is currently sponsoring a R1-million upgrade of the cardiac clinic, under its Unite for Health Programme.
Karen Sliwa has been conducting research in cardiomyopathy and heart failure since 1996, when she did her Phd on the subject. She is currently supervising seven Phd students studying different aspects of cardiovascular disease.
“Cardiovascular disease is very common worldwide, but 90% of the money goes to 10% of the diseases,” points out Sliwa. “Very little research is done on diseases that are common in Africa.”
The team: (from l to r) Bridget Pretorius (dietician), Kemi Tibazarwa, Dr Karen Sliwa (research co-ordinator), Grafford Relmatha (financial reporter), Rainy Masindi (administrator), Elizabeth Tshele (nursing sister), Patience Gumude (nursing sister), Nokululeko Ngwenya (clinical technologist), Dr Anthony Becker, Bridget Phooko (study co-ordinator), Richard Ndlovu (strategic business division, Bayer Healthcare), Tanja Steenekamp (cardiovascular product manager, Bayer Healthcare)
Why Study Cardiovascular Disease?
A typical ward at Chris Hani Baragwanath Hospital
Now, at the beginning of the third millennium, non-communicable diseases appear to be sweeping the entire globe, with a marked increase in developing countries. It is predicted that by 2020 non-communicable diseases will account for 80% of the global burden of disease, causing seven out of every 10 deaths in developing nations, compared with less than half today (WHO, 2002).
At the same time, infectious diseases continue to be a major cause of mortality in developing countries. Cardiovascular diseases cause around 17-million deaths, representing approximately one-third of all deaths, occurring in the world each year. Nearly 80% of these deaths occur in low- and middle-income countries, where the trend is increasing (Yusuf S. et al. 2001), indicating that by the year 2010 cardiovascular disease will be the leading cause of death, as a consequence of lifestyle changes brought about by industrialisation and urbanisation.
There is strong, reasonable evidence to suggest that South Africa is currently undergoing an epidemiological transition in terms of the incidence of the types of cardiovascular disease: rheumatic heart disease of the young, although still prevalent, is giving way to hypertension and acute (e.g. myocardial infarction) followed by chronic (e.g. heart failure) manifestations of coronary artery disease in older individuals. Subsequently, there is also a marked increase in chronic kidney disease and stroke. There is a paucity of information on the precise incidence and prevalence of each of these diseases specifically with reference to the associated cardiovascular risk factors and clinical presentations of emerging heart disease in the predominantly black African population (around 1-million people) living in Soweto or other similar communities within the Republic of South Africa. Such data are essential and vital for the institution of effective prevention and health-care service planning.
The Heart of Soweto study will help researchers better understand heart disease in Africa
Structural heart muscle disease such as Peripartum Cardiomyopathy (a weakening of the heart muscle in mothers shortly before and after the birth of a baby) and Idiopathic Cardiomyopathy (a weakening of the heart muscle due to unknown causes) are common conditions in South Africa. Peripartum Cardiomyopathy affects 1: 1000 black South Africans with a reported mortality of about 30% of the affected mothers. About 50% of patients diagnosed with symptomatic heart failure due to idiopathic dilated cardiomyopathy die within five years.
Dramatic developments can be expected in the research of “heart failure”, a condition which affects almost 5,000,000 people in the US. Epidemiological data are not available for Africa but preliminary results from the Heart of Soweto survey suggest about 30% of the cardiac population seen at Chris Hani Baragwanath Hospital present with some form of heart failure. While considerable advances have been made in our knowledge of such cardiovascular diseases, in particular knowledge gained with the institution of techniques utilising molecular biology, it also became increasingly clear from the results of such studies that the risk factors and primary etiological agents vary considerably and are unique to conditions, and host genetics, among other things. The delineation of these issues at the local level using clinical and basic science tools is imperative in efforts to put into place the infrastructure that is required for the prevention, treatment and management of these cardiovascular diseases. Applications of molecular biology in cardiovascular disease have been growing rapidly, and promise extraordinary future health benefit.
With this background, there is an urgent need to address this emerging epidemic of cardiovascular diseases and to develop formal research programmes. Conditions that are specific to Southern Africa need to be studied in our local environment. Little interest exists in other parts of the world to engage in research in particular diseases such as Peripartum Cardiomyopathy, since the pathogenesis and management of such diseases is of lesser importance to the western world.
The opportunities for translational research from basic science to the bedside represents enormous growth opportunities for academic medical centres. Indeed, it is the opportunity to link sophisticated investigator-initiated biological research with clinical expertise that most strongly differentiates academic medical centres from community providers and industry. However, in the case of clinicians involved primarily in clinical care, but who are focused on developing their programme to become an internationally recognised centre and with limited initial resources, it seems more appropriate to work under the slogan “From Bedside to Bench and Back”. In other words, as clinicians, we have the primary responsibility to provide clinical care to our patients. In the process, it is our desire and ambition to learn from the outcome of such patients’ care and the problems that exist with the aim to increase knowledge about the pathogenesis of those conditions and finally to improve the outcome of certain diseases.
Peripartum Cardiomyopathy is affecting 1: 1000 black South Africans with a reported mortality of about 30% of the affected mothers
The assimilation of such knowledge coupled with the definition of the existing gaps in our knowledge should lead to clearly thought out, hypothesis-based, creative research strategies to learn more about the disease, with a primary focus on how better to serve the patient with a priority for those diseases that are most selectively present in the geographical setting of our respective institution. These thoughts and ideas have to be taken to the lab, and a blueprint of the research to be performed needs to be formulated that can practically be performed with the least invasive techniques and which should theoretically lead to novel approaches and therapeutic strategies which could then be returned to the patient.
Such approaches require personnel, funds, adequate and appropriately equipped facilities, and a commitment that can be sustained for a defined time interval so that the initial investment has a fair chance to materialise.
Collaborators
Recent Research
- Incidence and characteristics of newly diagnosed rheumatic heart disease in Urban African adults: insights from the Heart of Soweto Study. (PDF; 686kb)
Sponsors
Links
Staff
Prof Karen Sliwa (co-ordinator)
Dr Kemi Tibazarwa (fellow)
Dr Anthony Becker (researcher)
Sandra Pretorius (dietician)
Elena Libhaber (researcher)
Dr Vinesh Vaghela (researcher)
Dr Lucas Ntyintyane (researcher)
Dr Robert Mvungi (fellow)
Dr Haroon Abbasi (researcher)
Dr Olaf Forster (researcher)
Bridget Phooko (research co-ordinator)
Maureen Kubekha (research co-ordinator)
Elizabeth Tshele (data manager)
Puthuma Mathuzi (research nurse)
Patience Gumede (nursing sister)
Louis Kuneka (ECG technologist and research co-ordinator)
Joe Maelane (senior clinical technologist)
Rainy Masindi (administrator)
Selby Mathinjwa
(driver)
Nokululeko Ngwenya (clinical technologist)