Why Africans Are Not Genetically Predisposed to Valvular Heart Disease

What today would be a 10,000-dollar problem, tomorrow might become a requirement for an LVAD or RVAD and turn into a quarter-million-dollar problem. It is only this afternoon that I wrote such an email for a 14-year-old girl from North Africa, asking for a quarter of a million dollars even to begin treating her. She is in complete heart-lung failure. She is the fourth sibling to have hereditary congenital pulmonary hypertension. Three of them have died.

Going to Africa to do camps is not the answer. That has been tried over the last 30 years by half a dozen people I know. It does not work. It is a financially profitable proposition to go and operate 30 to 40 cases and come back with a reasonable amount of money. But 30 or 40 lives saved is not an answer where 30 to 40 million lives are at stake. The answer is training, treating, and timing.

I would be happy to dedicate a little of my time for weekly or fortnightly consultations. I am happy to travel economy, live a very normal life for 10 to 15 days, and train a bunch of doctors in one specialty clinic on the ABCDs of seeing a valvular heart disease patient, the ABCDs of reporting it, how to follow them up in the community, and what the relevant paperwork looks like.

Africans are not genetically or racially predisposed to have valvular heart disease. It is primarily the socioeconomic factor which makes rheumatic heart disease such a huge problem, almost 20 times the global burden. The lowest rates of calcific and degenerative valvular disease are also found in Africa, which confirms this is not a biological phenomenon.

For stenotic lesions, whether mitral or aortic stenosis, we ought to be talking about orifice area, orifice area indexed to body surface area, pressure half time, and pressure gradients. For regurgitant lesions, it has to talk about jet surface area, vena contracta, pressure half times, and flow dynamics. You ought to be talking about valvular heart disease in terms of the AHA classification of A, B, C: at risk, progressive, and progressed.

Children contract group B streptococcal throat infections that progress to acute rheumatic fever and then chronic rheumatic heart disease when antibiotic treatment and healthcare access aren't available to stop the sequence, driving a burden more than twenty times the global average.

A similarly elevated pattern, since both would reflect an inherited vulnerability. Instead, Africa's calcific valvular disease incidence runs at 0 to 10 cases per million, among the lowest in the world, while continental Europe, Russia, Canada and New Zealand exceed 200 per million.

North Africa has better access to antibiotics and primary care, and its rheumatic heart disease burden sits close to developed-world levels despite sharing the continent with Sub-Saharan Africa.

Often not, despite being, by the surgeon's own account, as big a killer, if not more, once poverty, overcrowding, poor sanitation and limited antibiotic access are factored into the disease's true burden.