Elevated risk factors but low burden of heart disease in urban African primary care patients: A fundamental role for primary prevention

Simon Stewart, Melinda J. Carrington, Sandra Pretorius, Okechukwu S. Ogah, Lori Blauwet, Jocelyne Antras-Ferry, Karen Sliwa

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


Background: Few data describe the case burden of heart disease and cardiovascular risk factors relative to other conditions in urban Africans seeking primary health care. Methods: A clinical registry captured data on 1311 consecutive primary care patients (99% African) from two primary care clinics in Soweto, South Africa. Those with suspected sub-clinical heart disease had more advanced cardiologic assessment. Results: Overall, 862 women (66%, 41 ± 16 years) and 449 men (38 ± 14 years) were studied. Whilst more men were smokers (47% vs. 14%; OR 5.23, 95% CI 4.01-6.82), more women were obese (42% vs. 14%; OR 4.54, 95% CI 3.33-5.88); blood glucose levels doubling with age in obese women. Although 33% were hypertensive, only 4.9% had type 2 diabetes (n = 45), heart disease (n = 10) and/or cerebrovascular disease (n = 12). Overall, 16% (n = 205) had an abnormal 12-lead ECG with more men than women showing a major abnormality (24% vs. 11%; OR 2.63, 95% CI 1.89-3.46). Of 99 cases (7.6%) subject to advanced cardiologic assessment, 29 (2.2%) had newly diagnosed heart disease: including hypertensive heart failure (13 women vs. 2 men, OR 4.51 95% CI 1.00-21.2), coronary artery disease (n = 3), valve disease (n = 3), dilated cardiomyopathy (n = 3) and 2 cases of acute myocarditis. Conclusions: These data demonstrate a relatively low burden of heart disease in urban African patients seeking primary health care. Alternatively, high antecedent risk, particularly among obese women, highlights a key role for enhanced primary prevention.

Original languageEnglish
Pages (from-to)205-210
Number of pages6
JournalInternational Journal of Cardiology
Issue number2
Publication statusPublished - 12 Jul 2012
Externally publishedYes


  • Cardiovascular diseases
  • Diabetes mellitus
  • Obesity
  • Prevention
  • Risk factors


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