Ischaemic heart disease in Africa.

Ischaemic heart disease (IHD), previously considered rare in sub-Saharan Africa, now ranks 8th among the leading causes of death in men and women in the region. Furthermore, the prevalence of IHD and related morbidity may be increasing as a result of adverse behavioural and lifestyle changes associated with urbanisation and the epidemiological transition. The major risk factors for IHD in sub-Saharan Africa include hypertension, smoking, diabetes, abdominal obesity and dyslipidaemia. In the INTERHEART Africa study, these risk factors contributed a population-attributable risk of nearly 90% for acute myocardial infarction. Many cost-effective interventions exist at the individual and population levels, and they are likely to have a significant health impact in Africa. An aggressive approach that combines environmental, policy and legislative interventions for health promotion and primary prevention, coupled with improved access to evaluation, treatment and control of hypertension and other major risk factors, provides the best strategy for averting an epidemic of IHD in sub-Saharan Africa.