The burden of cardiovascular disease (CVD) should never be underestimated. Globally 17.5 million lives are lost due to CVD. In South Africa 18% of all deaths among individuals between 30 and 70 years are from CVD. Consequently, heart disease, stroke and other circulatory diseases have enormous direct and indirect impact.
Given the scale of the problem, it is important that we prioritise key population groups so that we can have a systematic approach to a comprehensive plan to reduce premature deaths from cardiovascular disease by 25% overall and a reduction by 25% among those under the age of 25 by the year 2025.
The collective of researchers, clinicians, professional bodies, civil society organisations and the public-private sector initiatives, who have a commitment to the 25x25<25 target, have aligned their thinking to those of international leaders in the field such as the World Heart Federation (WHF) and the World Health Organisation (WHO).
It is also important to remember that as a country we need to be committed by the Sustainable Development Goals as promulgated by the UN and in particular Goal 3 which states that: "Ensure healthy lives and promote well-being for all at all ages."
Given that CVD is largely preventable, this opinion piece focuses on heart disease among pregnant women, and young people, including children with rheumatic heart disease (RHD) as vulnerable groups in which we should be investing in to reduce the burden of CVD.
Rheumatic heart disease is the most common type of acquired heart disease in children and young people below the age of 25 years which claims 275000 lives annually and affects 33 million people.
According to the global movement RHD Action, there were 42600 cases of rheumatic heart disease in South Africa in 2013, a 55% increase since 1990. Three times more girls and women are affected compared to males.
Women with RHD often present with symptoms of heart failure when they are pregnant. With improved living conditions and the discovery of antibiotics, RHD has all but disappeared in high-income countries but still largely affects the poor and vulnerable.
The bacteria, Group A streptococcus, which is the antecedent infection (usually as Strep throat) spreads easily in densely populated informal areas and where hygiene is poor.
Impoverished communities often don’t have easy access to routine medical care or the ongoing medication, follow-up appointments and expensive medical surgery that rheumatic heart disease requires.
The focus on CVD among women in general, including women who are pregnant, is often overlooked despite the fact that hypertension in women less than 45 years is more common than in men and the fact that Diabetes Mellitus increased globally equally in men and women.
Moreover, hyperlipidemia increases after menopause. It is known that total cholesterol increases on average by 10% after menopause. Another risk factor for women is obesity.
Obesity among women is increasing globally and unfortunately women are also less physically active. Tobacco smoking which triples the risk for CVD is also on the rise among women and young girls.
Consider the following facts:
Cardiac problems in the peripartum period are an important cause for illness. Being short of breath while pregnant or post-partum can be due to a heart problem
Children can also have heart disease, both rheumatic heart disease and congenital heart disease - in fact it is the most common birth defect.
RHD is the most common acquired heart disease in children and young adults in many countries of the world. Developing countries are disproportionately affected.
RHD is caused by rheumatic fever which is an abnormal immune reaction launched against a common bacterium called "Group A Streptococcus".
Acute rheumatic fever is hallmarked by joint pain, fever above 38°C, feeling generally unwell and tired with shortness of breath, sometimes a skin rash, and uncontrolled body movements.
Rheumatic heart disease further places pregnant women at great risk during labour and delivery.
The disease requires lifelong medication, medical surveillance and often heart valve replacement surgery. The good news is that CVD in general and rheumatic fever in particular can be completely prevented.
To prevent a child from the onset of rheumatic heart disease, care-givers need access to medical treatment so that a child with a suspected throat infection can be treated. CVD associated with pregnant women is also largely preventable.
Consequently advocates in the health sector, NGOs and civil society groups should make a point of becoming actively involved in forums that have the power to influence health authorities and other health-care providers to provide appropriate and timeous treatment to especially vulnerable people such as women and children.
Given that up to 80% of CVDs can be prevented, communities need to be given the necessary knowledge and mobilised to promote health well-being.
Naidoo is the Chief Executive of the Heart and Stroke Foundation South Africa, Professor at UWC and Stellenbosch University.
Zühlke is a Professor at UCT, Director of the Children’s Heart Disease Research Unit at UCT and President of the South African Heart Association.
Sliwa is a Professor and Director of the Hatter Institute in the Faculty of Medicine and Health Sciences at UCT.