Breaking barriers of Atherosclerotic Cardiovascular Diseases (ASCVD) in Africa - Call to action

Jane, a young professional working for a bustling savings and loans company in Accra, is under immense pressure to reach her assigned target of recruiting at least three new customers monthly.

Her health is deteriorating quickly as a consequence of the constant stress and underlying hypertension. 

She has started experiencing symptoms such as tiredness, chest pain and shortness of breath, unaware that her body is steadily succumbing to the grip of Atherosclerotic Cardiovascular Disease (ASCVD.) 

Such anecdotes are widespread in Africa, where stress is causing hypertension and other risk factors of ASCVD.

ASCVD has emerged as a major global health concern, claiming millions of lives and putting pressure on healthcare systems across the globe. 

While the burden of this disease in developed countries is well-known, Africa has unique challenges that inhibit effective prevention, diagnosis and treatment, putting countless lives at risk.

In 2019, more than one million deaths in sub-Saharan Africa were attributed to CVD, constituting 5.4 per cent of all global CVD-related deaths and 13 per cent of all deaths in Africa, according to the World Heart Federation. 

To address this pressing issue and overcome the barriers, several global health institutions have called for a concerted effort to deepen disease knowledge and investigate solutions to this challenge. 

Earlier this year, I attended a Dyslipidemia Summit in Ghana organised by Novartis, a multinational healthcare organisation, where I shared valuable information about the disease's prevalence and treatment choices. 

The conference also identified major knowledge gaps on the risk factors for ASCVD and highlighted the barriers to illness identification and treatment. 

Dispelling cultural myths 

One key hindrance to tackling ASCVD in Africa is the apparent need for more awareness and understanding of the condition, leading to false beliefs, cultural interpretations and myths.

Cultural undertones like “ASCVD only affects the elderly”, “ASCVD is only for the affluent”, “traditional remedies are sufficient to manage ASCVD”, or “ASCVD is a natural consequence of ageing” must be corrected through adequate education and awareness. 

We can empower people to make informed choices regarding cardiovascular health and support preventative steps by bridging the gap between cultural misconceptions and scientific facts to enhance public health.

Educative programmes for healthcare professionals and the general population should be strengthened. 

By learning more about the risk factors, early warning signs and preventive measures, individuals will be empowered to care for their cardiovascular health for improved health outcomes.

Strong institutional partnership for diagnosis

There is no denying that identifying and treating ASCVD is a financial burden on the typical Ghanaian or African.

In Ghana, support from the National Health Insurance Authority (NHIA) by enlisting some treatments on the reimbursement list helps, yet barriers to accessing care still exist. 

Budgetary constraints, cultural belief systems and inadequate infrastructure contribute significantly to many individuals selecting traditional remedies over recognised therapeutic choices. 

Institutional collaborations can pool resources, knowledge, and money from various stakeholders, including governments, healthcare providers, pharmaceutical corporations and non-profit organisations to reduce the cost burden. 

One important area where institutional collaboration may make a difference is lowering the cost of critical diagnostic tests.

Also, medications such as statins, antiplatelets, antihypertensive and other essential drugs for controlling ASCVD and avoiding complications have become costly, restricting access, particularly for many Africans. 

Partnerships may be used to negotiate lower pricing with diagnostic equipment manufacturers, get funds from the NHIA for subsidised or free testing programmes and medications, and promote knowledge transfer for local diagnostic solutions.

Addressing healthcare infrastructure for access

Another significant barrier to addressing ASCVD in Africa is the condition of the healthcare infrastructure.

Limited access to basic care driven by socio-economic factors, limited diagnostic equipment and specialised cardiovascular services hinder early identification and successful therapy. 

To address this, investments in healthcare infrastructure, such as the availability of well-equipped clinics, cardiovascular centres and competent healthcare workers throughout the continent should be prioritised on national health agendas, and appropriate resources should be allocated.  

Again, Africa must prioritise research and innovation to combat ASCVD. The prime age group of 40-60 have higher risks of high blood pressure, diabetes, obesity and high cholesterol. 

Ghana has a significant youth population, approximately 57 per cent under 25, which means there is a potential risk for young people with CVDs.

Research would address the unique genetic and environmental factors and explore innovative approaches such as precision medicine, personalised risk assessment and tailored therapies for Africa.

An integrated approach is necessary to break down the hurdles to ASCVD in Africa.

We can build a future where ASCVD is no longer a primary cause of morbidity and death in Africa by raising awareness and strengthening healthcare systems with Institutional and government partnerships for legislative reform and the provision of subsidies by the government. 

Only through these interventions, among many others, can the battle against ASCVD be won to ensure a healthy future for all Africans.

The writer is a Professor of Neurology at the University of Ghana Medical School/Consultant Neurologist at the Korle Bu Teaching Hospital/one of three professors of Neurology in Ghana.

E-mail: niialloteybernard1@gmail.com