Ntusi Ntobeko B A, Mayosi Bongani M
Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
Expert Rev Cardiovasc Ther. 2009 Feb;7(2):169-80. doi: 10.1586/14779072.7.2.169.
Heart failure has emerged as a dominant form of cardiovascular disease in Africa, and has great social and economic relevance owing to its high prevalence, mortality and impact on young, economically active individuals. The causes of heart failure in Africans remain largely nonischemic. Hypertension, cardiomyopathy, rheumatic heart disease, chronic lung disease and pericardial disease are the main contributors to the etiology of cardiac failure in sub-Saharan Africa, accounting for over 90% of cases. Hypertensive heart disease complications occur more frequently in Africans and the majority of affected patients are younger. Endemic cardiomyopathies include dilated cardiomyopathy, peripartum cardiomyopathy and endomyocardial fibrosis. Nonendemic cardiomyopathies apparently occur with the same frequency as in other parts of the world, and include hypertrophic cardiomyopathy and arrhythmogenic right ventricular dysplasia/cardiomyopathy. Coronary artery disease and its complications remain uncommon in Africa, but the situation is changing due to modifications in lifestyle, risk-prone behavior, diet, cultural attitudes and other consequences of rapid urbanization. As the prevalence of heart failure is expected to rise substantially in sub-Saharan Africa, the authors call for population-based studies and registries of the epidemiology of heart failure in Africans and the urgent study of interventions that will decrease morbidity and mortality from the causes of heart failure, with a focus both on nonischemic and ischemic risk factors.
心力衰竭已成为非洲心血管疾病的主要形式，因其高患病率、高死亡率以及对年轻且具有经济活动能力的个体的影响，而具有重大的社会和经济意义。非洲人心力衰竭的病因在很大程度上仍为非缺血性。高血压、心肌病、风湿性心脏病、慢性肺病和心包疾病是撒哈拉以南非洲心力衰竭病因的主要促成因素，占病例的90%以上。高血压性心脏病并发症在非洲人当中更为常见，且大多数受影响患者较为年轻。地方性心肌病包括扩张型心肌病、围产期心肌病和心内膜心肌纤维化。非地方性心肌病的发生率显然与世界其他地区相同，包括肥厚型心肌病和致心律失常性右心室发育不良/心肌病。冠状动脉疾病及其并发症在非洲仍然不常见，但由于生活方式的改变、易患风险行为、饮食、文化观念以及快速城市化带来的其他后果，这种情况正在发生变化。鉴于撒哈拉以南非洲心力衰竭的患病率预计将大幅上升，作者呼吁开展基于人群的非洲人心力衰竭流行病学研究和登记，并迫切研究能降低心力衰竭病因所致发病率和死亡率的干预措施，重点关注非缺血性和缺血性风险因素。
