Cardiovascular pathology in African and Afro-Caribbean blacks features three major conditions: hypertension, rheumatic heart disease, and the cardiomyopathies. Ischemic heart disease is as yet distinctly uncommon in these societies but the adoption of Western lifestyle and its inevitable risk factors for atherosclerosis makes it likely that coronary artery disease will emerge ultimately. Hypertension poses special problems in these regions--its prevalence rate is high both in rural and urban settings, its consequences devastating in its severity of target organ involvement, and its management strategy complicated by the high cost of drugs, poor patient compliance, and the lack of clinical resources for effective monitoring of detected and referred cases. Rheumatic heart disease remains an eminently preventable condition. The ultimate strategy lies in improving the quality of life in these communities through adequate housing, sanitation, and health education, and integrating primary prophylaxis into national health care programs to forestall the development of rheumatic fever. Cardiomyopathy poses the greatest challenge as its etiology remains elusive. Its dilated form has been linked with Toxoplasma and with Coxsackie B viruses, but hard evidence of a cause-effect relationship is still lacking.
The intent in this chapter has been to bring to general awareness the fact that myocardial dysfunction represents a significant proportion of cardiovascular disease affecting blacks; in particular, dilated cardiomyopathy is a new frontier in cardiology, which demands an aggressive approach. At present, the prognosis is not good in the majority of cases; despite the best medical therapy, most of those with cardiomyopathy are doomed to death within a few years after the onset of congestive heart failure. Many of these are young African-American men in the prime of their lives. Cardiac transplantation offers some hope from this desperate situation, but donor shortages as well as restrictive criteria for prospective recipients and socioeconomic constraints, which may deny many blacks the opportunity to receive a transplant, make this option less than ideal.
It is difficult to draw strong conclusions from the available data. One must simply accept the fact that vital statistics show that cardiovascular disease is the most common cause of death among black Americans. Health care providers, policymakers, and funding agencies should use this information to develop preventive and therapeutic strategies to conquer this dreadful disease.
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