title: Elevated risk factors but low burden of heart disease in urban African primary care patients: a fundamental role for primary prevention.
abstract: 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.
authors.affiliation: Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia. simon.stewart@bakeridi.edu.au
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Carrington
authors.forename: Sandra
authors.initials: S
authors.lastname: Pretorius
authors.forename: Okechukwu S
authors.initials: OS
authors.lastname: Ogah
authors.forename: Lori
authors.initials: L
authors.lastname: Blauwet
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Antras-Ferry
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
mesh_terms: D000328:Adult; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011322:Primary Prevention / Q000379:methods*; D012042:Registries; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult