Heart of Soweto
Citation for Dr Lucas Mthetheli Ntyintyane
Degree: Doctor of Philosophy (PhD) 2009, University of the Witwatersrand
Title of thesis: The characteristics of coronary artery disease in Soweto
An epidemiological transition is occurring in the developing world. The major causes of death are changing from infectious diseases to non-communicable diseases such as coronary heart disease. Much of this transition is caused by changes in lifestyle.
The aim of Dr. Ntyintyane’s thesis was to assess metabolic parameters in African subjects from Soweto with established coronary heart disease. He demonstrated abnormal glucose regulation, increased lipid levels post meal, and a high prevalence of central obesity and the metabolic syndrome in these subjects. These findings predict a rapid increase in the prevalence of coronary heart disease amongst our urban Black population as they adopt a Western lifestyle.
Heart of Soweto study published
Preliminary findings from the Heart of Soweto Registry 2006 have been released. The Heart of Soweto study aims to improve our understanding of the characteristics and burden imposed by cardiovascular disease (CVD) in an African setting.
The team identified 4 162 cases of cardiovascular disease (1 593 newly diagnosed) in 2006. While the mean age was 54 years, almost a quarter were aged below 40 years. The five most common diagnoses overall were hypertension (54%), heart failure (47%), valvular heart disease or dysfunction (32%), coronary artery disease (15%) and diabetes (10%).
Prevalence of CVD risk factors was very high; only 13% had no risk factors while 47% of patients with hypertension were obese.
Overall, this data provided good evidence to show that the phenomenon of epidemiologic transition in Soweto, South Africa, has broadened the complexity and spectrum of heart disease in this community. We found multiple threats to the current and future heart health of Soweto from a high prevalence of modifiable risk factors for atherosclerotic disease, a combination of infectious and non-communicable forms of heart disease and late clinical presentation. [Download pdf]
A collaborative project between University of the Witwatersrand, Republic of South Africa & The University of Queensland, Australia
The Heart of Soweto Study: a unique study of the emerging causes and consequences of cardiovascular disease in South Africa. (Please also visit our Heart Awareness Days page.)
Financially supported by Adcock Ingram/Tigerbrands (Unite 4 Health)
Research team
- Prof Karen Sliwa
- Prof Simon Stewart
- Prof David Wilkinson
- Prof John McMurray
- Dr Lucas Ntyintyane
- Dr Kemi Tibazarwa
- Dr Craig Hansen
Research staff
- Bridget Phooko
- Maureen Kubekha
- Elisabeth Tshele
- Louis Kuneka
- Puthuma Methusi
Background
There is strong evidence to suggest that the Republic of South Africa (RSA) is currently in epidemiological transition 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 manifestations (e.g. heart failure) of coronary artery disease in older individuals.
However, we do not know in detail the cardiovascular risk factors and clinical presentations of emergent heart disease in the predominantly black African population (around 1.2 million people) living in Soweto or other similar communities in Africa. Such data are vital for effective prevention and health care service planning.
The Heart of Soweto Study
Is a collaborative project, bringing together internationally renowned academics, that will examine the following research questions in relation to the emergence of heart disease in Soweto and other African communities in epidemiological transition:
- Have the profound political and socio-economic changes in South Africa negatively impacted on the cardiovascular risk behaviour profile and subsequent incidence of heart disease?
- Is an increasing incidence of HIV, compounded by the recent introduction of anti-retroviral therapy associated with a parallel increase in acute myocardial infarction due to thromboembolic events?
- Will culturally specific programs focussed on primary/secondary prevention and chronic disease management initially based at Baragwaneth Hospital and extending to nurse-led community centres in Soweto improve the risk factor profile and cardiac-related outcomes in that community?
Consistent with the research questions listed above, the Heart of Soweto Study comprises three distinct projects that will provide a wealth of information concerning the emergence and consequences of heart disease in an internationally celebrated and renowned community:
- A prospective registry of more than 12,000 men and women from Soweto presenting to the Baragwanath Hospital with heart disease (study design published in International Journal of Cardiology, 2006; see PDF).
- A case-control study of HIV positive and negative patients presenting to the Coronary Care Unit with an acute coronary syndrome (PhD project Dr. Becker).
- A randomised controlled study of a multidisciplinary, community-based, chronic heart failure management program in Soweto.
The Heart of Soweto Study will provide definitive evidence of the impact of socio-economic changes to the cardiovascular health of this urban African community and develop community-based program of health care in response. In the process, the team of internationally renowned investigators will build local research capacity to develop a sustainable program of research and health service development to minimise the impact of an emerging health problem. They envision that both the process of undertaking the “Heart of Soweto Study” and its research outcomes will have significant implications for the millions of individuals living in similar urban communities in epidemiological transition throughout South Africa and other parts of the African continent.
Also read about our Heart Awareness Days, which form part of the Heart of Soweto study.
For more details please contact:
Professor Karen Sliwa
+27 11 9338197 (phone)
+27 11 9388945 (fax)
Karen.Sliwa-Hahnle@wits.ac.za
Heart of Soweto Published Research
Stewart S, Libhaber E, Carrington M, Damasceno A, Abbasi H, Wilkinson D, Hansen C, Sliwa K. The clinical consequences and challenges in urban hypertension in Africa: Insights from Heart of Soweto Study. Int J Cardiol 2009;in press
Stewart S, Sliwa K. Preventing CVD in resource-poor areas: perspectives from the ‘real world’. Nature Reviews Cardiology 2009;in press
Heart Awareness Days
Find out more about our Heart Awareness Days.
Photos
SOCRU Team
Visiting students Cameroon Naidoo and Kranti Gallopudi ( USA) and University of the Witwatersrand visiting professor Prof. Simon Stewart, Geraldine Lee and Dr. Melinda Carrington.
(From l to r) Dr Kemi Tibazarwa (fellow), Maureen Kubekha (research assistant), a visiting patient, Grawford Ralematha (research assistant), Prof David Wilkinson (visiting professor at Wits from the University of Queensland), Dr Craig Hansen (University of Queensland).
Dr Lucas Ntyintyane.
Petra de Nobrega with Prof Simon Stewart, visiting professor at Wits from Baker Institute, Australia.
Resources
- Summary graphic of the Heart of Soweto study. (Download this slide in PDF format; 160kb)
- Mapping the emergence of heart disease in a black, urban population in Africa: The Heart of Soweto Study. International Journal of Cardiology. (PDF; 686kb)