Cardiovascular disease in very low income sub-Saharan Africa: informing the response to an emerging epidemic

I will improve understanding of key determinants and the incidence of cardiovascular disease in low-income sub-Saharan-Africa, capitalising on my expertise in stroke epidemiology in rural and urban Malawi and the research infrastructure across seven sub-Saharan-Africa population cohorts. Information on the age- and sex-specific incidences of priority cardiovascular diseases is essential for health service planning in sub-Saharan-Africa. “Traditional” risk-factors (hypertension, type-2 diabetes and obesity) are highly prevalent and increasing in incidence and some, particular to low-income settings, such as chronic-infections, are not declining. The performance of diagnostic tools and risk prediction scores for cardiovascular disease developed in high-income settings need to be tested and adapted for use in low-income sub-Saharan-Africa. I will build on the urban/rural cohort in Malawi, extending community and clinic surveillance with population-level questionnaire-screening (followed by a diagnostic pathway in those with “possible cardiovascular disease”) to estimate the true incidence of various cardiovascular diseases. I will also extend the follow-up for our seven African cohorts and use this harmonised dataset to estimate the relative contributions of key drivers of cardiovascular disease and assess the performance of existing cardiovascular disease risk prediction scores. This work will inform the planning of evidence-based, health-systems responses and context-relevant, individual, and population-level interventions.