Heart Failure and Coronary Artery Disease in the African Population

The evidence is unambiguous: any form of alcohol predisposes to cardiac dysfunction. Traditional drinks have been examined alongside commercially available alcohol in studies, and the myth that red wine protects the heart has been comprehensively debunked. Chronic alcohol consumption damages the heart, full stop. Whether someone chooses to drink socially is a personal decision, but scientifically there is no basis for recommending any alcohol for cardiac health.

You do not manage it — you accept it, because that is your best option to open the coronary artery blockage. The bleeding risk is only a problem in a living patient. If the patient dies from a myocardial infarction for lack of intervention, there is no bleeding to manage.

It should be started at the lowest possible dose — half a tablet, 25mg once daily, titrated over a week to 50mg, then 100mg, not typically exceeding 100mg once daily or 50mg twice daily. The primary indication is ejection fraction below 45% with elevated NT-proBNP. In a patient with ejection fraction below 35% and high NT-proBNP, it should be initiated at the lowest dose and titrated carefully upward.

In Africans and Asians, coronary artery disease is largely driven by genetic predisposition. In Caucasians, the predominant driver is sedentary lifestyle combined with diet — high-fat foods, alcohol, physical inactivity — which more than compensates for their lesser genetic predisposition. Surgical outcomes are comparable worldwide, with success rates upward of 90% and combined morbidity and mortality after CABG around 5 to 7% regardless of country. But the numbers in Asia and Africa are hugely underrepresented — if one million cardiac deaths annually in sub-Saharan Africa is the current reported figure, the true number with adequate diagnostic infrastructure would likely be closer to three million.

The traditional Indian vegetarian population was genuinely following something close to this diet. What changed was cooking oil. Industrial cooking oils were repackaged and marketed under omega fatty acid branding — omega-3, then omega-6, now omega-9 — persuading consumers to abandon traditional cooking fats like mustard oil and olive oil for artificially processed, packaged products whose health claims aren't supported by meaningful clinical evidence. If the population simply returned to traditional cooking oils, it would likely cut the cardiac disease burden significantly. The pyramid isn't the problem; the oil in the pan is.

He is Consultant in Heart & Lung Transplant and Vascular Surgery at Artemis Hospitals, Gurgaon. His Jivo Masterclass explains why heart failure and coronary artery disease behave differently across Africa than almost anywhere else in the world.

It arrives roughly a decade earlier, is diagnosed later, and is frequently treated on medications that are already outdated by the time a patient reaches a specialist.

Hypertension, rheumatic disease, HIV and tuberculosis, the conditions driving the bulk of heart failure across the continent.

It kills roughly twice as many people in sub-Saharan Africa each year as cancer does.