Coronary artery disease in Africa and the Middle East

Abstract

Countries in Africa and the Middle East bear a heavy burden from cardiovascular disease. The prevalence of coronary heart disease is promoted in turn by a high prevalence of cardiovascular risk factors, particularly smoking, hypertension, dyslipidemia, diabetes, and sedentary lifestyles. Patients in Africa and the Middle East present with myocardial infarction at a younger age, on average, compared with patients elsewhere. The projected future burden of mortality from coronary heart disease in Africa and the Middle East is set to outstrip that observed in other geographical regions. Recent detailed nationally representative epidemiological data are lacking for many countries, and high proportions of transient expatriate workers in countries such as Saudi Arabia and the United Arab Emirates complicate the construction of such datasets. However, the development of national registries in some countries is beginning to reveal the nature of coronary heart disease. Improving lifestyles (reducing calorie intake and increasing physical activity) in patients in the region will be essential, although cultural and environmental barriers will render this difficult. Appropriate prescribing of pharmacologic treatments is essential in the prevention and management of cardiovascular disease. In particular, recent controversies relating to the therapeutic profile of beta-blockers may have reduced their use. The current evidence base suggests that beta-blockers are as effective as other therapies in preventing cardiovascular disease and that concerns relating to their use in hypertension and cardiovascular disease have been overstated.

Keywords: beta-blockers; cardiovascular disease; cardiovascular risk factors; coronary heart disease; heart failure.

Figure 1

Death rates from cardiovascular disease in selected countries in Africa and the Middle East. Drawn from data presented by the World Health Organization.

Figure 2

Trends in total cigarette consumption in the World Health Organization Eastern Mediterranean and Americas regions. Drawn from data presented by Guindon et al.

Figure 3

Demographic shift in North Africa: increased burden of ischemic heart disease (IHD) and decreasing burden of rheumatic heart disease (RHD) in hospitals in Tunisia.