Geographic Variation in Types of Heart Disease

In many parts of the world, other types of heart disease are more common than coronary heart disease. Endomyocardial fibrosis, for example, is common in the tropical rain forest belt of Africa and South America. The disease has a characteristic pathological process and leads to heart failure, accounting for up to 20 percent of patients with heart failure in Uganda, the Sudan, and northern Nigeria. It can affect people who live in the area as well as those who visit from other parts of the world. Although its precise cause is unknown, and in some instances it may be due to a parasitic infection, the underlying cause may be an increase in the number of eosinophils. In many parts of South America, the parasite Schistosoma mansoni is a common cause of heart disease. Also common in South America is Chagas' disease. Other heart diseases having characteristic geographic patterns include some forms of congenital heart disease that are more significant for people who live at high altitudes, where the concentration of oxygen in the inspired air is reduced.

Peripartum cardiac failure is developed by up to 1 percent of women in northern Nigeria during the postpartum period. Occurring most often in July, it seems to be caused by a combination of extreme heat, exhaustion exacerbated by the traditional custom of lying on a bed over a fire, and eating food rich in lake salt. Thus, peripartum cardiac failure appears to be largely a result of cultural patterns. In this respect it resembles coronary heart disease, which is linked to Western culture in ways that we identify as risk factors and in ways that we do not fully understand, as exemplified by the impact of Japanese cultural values on coronary disease just described.

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