The changing spectrum of coronary artery disease in black African patients at a tertiary institution : a one year experience.

Abstract

The spectrum of coronary artery disease among Black African patients in South Africa is not completely known. Previous reports have described acute coronary syndrome (ACS) in Blacks as uncommon. Studies have shown that Blacks have milder coronary artery disease compared to other population groups. More recently, reports are showing a rising number of cardiovascular risk factors and myocardial infarction in this population group. There is currently a paucity of local data looking at the growing burden of this disease and the spectrum of presentation in Black African populations. The aim of this study was to describe the spectrum of coronary artery disease in Blacks and determine if there were significant differences in severity and outcome as compared to more usually affected population groups with coronary artery disease. A retrospective chart review of Black African patients with acute coronary syndrome was conducted at Grey’s Hospital, with data obtained over a twenty month period at our tertiary referral centre. Blacks were compared with an equivalent number of Indian and Caucasian subjects presenting with acute coronary syndrome during the same period. The clinical presentation, biochemistry and angiographic findings were examined. The prevalence of acute coronary syndrome in Blacks was similar to Caucasians (17% v. 19%) but lower than Indians (64%). Except for family history (5%), traditional risk factors occurred as frequently in Blacks as in Indians and Caucasians. The prevalence of diabetes mellitus in Blacks (46.8%) was almost identical to Indians (50%). Hypertension (67%) was similar to Indians and Caucasians, but dyslipidaemia (56%) and smoking (41%) was lower among Blacks. Metabolic syndrome occurred as frequently in Blacks as in Indians. Black African patients had comparable coronary vessel involvement to Caucasians (single and double vessel disease), but less three vessel disease (18%). They were more likely to present, ab initio, at a younger age compared to Caucasians, with less preceding angina and with anterior ST segment elevation myocardial infarction. In conclusion, the study shows that Black African patients have become a high risk group with coronary artery disease than previously thought. It shows that coronary artery disease in Blacks is no longer an uncommon problem and that they should be considered a high risk group of patients with a cardiovascular risk that is comparable to Indians and Caucasians. Aggressive screening and treatment of cardiovascular risk factors should be undertaken with the same seriousness as in other usually affected population groups.