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[Coronary disease in black Africans: epidemiology, risk factors, clinical symptomatology and coronarography,
1Faculté de Médecine de Marseille, Hôpital Nord.
Insights
Coronary heart disease is increasing in Abidjan, with similar risk factors to Europe but lower risk index. Myocardial infarctions are common, with high in-hospital mortality and long-term increased mortality in Africans compared to Europeans.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Coronary heart disease (CHD) incidence has been rising globally.
- Understanding the epidemiology and risk factors of CHD in sub-Saharan Africa is crucial for targeted interventions.
- Previous studies in Abidjan indicated a stable incidence of CHD within cardiovascular diseases.
Purpose of the Study:
- To analyze the epidemiological data, risk factors, clinical presentation, and outcomes of coronary heart disease in Abidjan.
- To compare CHD characteristics in Black Africans with those in European populations.
- To evaluate the potential impact of advanced treatments like thrombolysis and angioplasty.
Main Methods:
- Retrospective analysis of epidemiological data on coronary heart disease published since 1952.
- Review of risk factors, clinical signs, and disease manifestations including myocardial infarction, angina pectoris, and silent ischemia.
- Coronary angiography to assess coronary artery lesions, spasms, and ventricular function.
Main Results:
- CHD incidence in Abidjan stabilized at 6-7% of cardiovascular diseases. Risk factors are similar to Europe, but the risk index is lower.
- Myocardial infarction was the most frequent manifestation (48.8%), often the first sign (40%). In-hospital mortality was 15%, with higher long-term mortality in Africans.
- Coronary angiography revealed normal arteries in 18.8% of CHD patients and 19.9% post-infarction, possibly due to spasms or recanalized thrombosis. Single-vessel disease was common.
Conclusions:
- Coronary heart disease in Black Africans shares similarities with young Western men, particularly regarding myocardial infarction presentation and outcomes.
- Despite similar risk factors, lower risk index and higher long-term mortality suggest unique pathophysiological aspects or disparities in care.
- Advanced treatments like thrombolysis and angioplasty could be beneficial but face significant accessibility challenges in Black African settings.
Abstract:
The study of the epidemiological data (published since 1952) seems to show an increasing frequency of the coronary disease for 15 last years. But this incidence seems to reach a stable level about 6 to 7% of the cardiovascular diseases at the Abidjan Institute of Cardiology; and 3.17% in a study in 13 countries but without coronarography (except at the Abidjan Institute). The study of the risk factors show that they are the same ones than in Europa. The risk index in Black Africa was 2.1 to 2.7 risk factor patient. These numbers are lesser than the risk index noted in France (3.6 in coronary patients and 1.9 in non-coronary subjects). The signs of the disease show that myocardial infarctions were frequent (48.8%) and often were the first manifestations of the coronary disease (40%). Angina pectoris was observed in 32.2%, an ischemic cardiomyopathy in 6.6% and a ventricular aneurysm in 6.6%. A silent ischemia was observed in 5.5% among at risk diabetic patients. The in-hospital mortality after myocardial infarction was 15% and was the same in European and African patients. But the mortality in Africans was greater than in Europeans the next years. Coronarography showed that 18.8% of the patients with coronary disease had normal coronary arteries. The arteries were also normal in 19.9% of the patients examined after an infarction. These high percentages can be related to coronary arterial spasms or to recanalized thrombosis. A spontaneous spasm was observed in 6.6% of the patients (a provoked coronary arterial spasm was not studied. The coronary arterial lesion was an one artery disease in 38.8% of the coronary patients and 50% of the patients with infarction. The stenosis were frequently proximal (82.6%) and the anterior descending artery was interested in 45.6%. Ventricular aneurysms were observed in 56.6% and the ejection fraction was lower than 0.50 in 63.3%. These data permit to compare the myocardial infarction of Blacks with the myocardial infarction of the young occidental men. We can think that thrombolysis or angioplasty would be very useful but they are often impossible in the Black African conditions.