**11.2. Individual level strategies (crucial)**

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...* 

arrhythmias [24].

they occur [27].

See **Table 1** below.

Congenital heart disease

Endomyocardial fibrosis

Rheumatic heart disease

**10. Causes of heart diseases in SA**

NCDs particularly in primary health care setting.

these policies however, remain a challenge.

*Neglected causes of cardiovascular diseases and their causes.*

**10.1 Neglected causes of cardiovascular diseases and their causes**

How to destress, a different approach that includes preventive and promotive health is needed. There is a direct link between stress and heart health. High emotional stress, isolation and loneliness have been linked to atrial and ventricular

Causes of CVD in SSA are hypertension, cardiomyopathy, rheumatic heart disease and congenital heart disease [26]. One multicentre study on PHC in SA revealed that primary care is dominated by NCDs and the most common diagnosis and reason to attend PHC being hypertension and HIV ranking third [25]. Death rates from non-communicable diseases in SA now exceed those of TB and HIV combined [25] and cardiovascular diseases are leading the NCDs. Obesity (68% of women and 31% of men) is another culprit [25]. The high burden of HIV directs most health care spending towards antiretroviral treatment, limiting funds for

Neglected CVDs in SSA are endomyocardial fibrosis, congenital heart diseases, and rheumatic heart disease [26]. Rheumatic fever affects children in low resource settings where poverty is rife, overcrowding and poor sanitary conditions and limited access to health care services. Rhematic heart disease can be prevented by preventing streptococcal infections or treating them early when

Congenital heart disease: Genes and environmental factors are associated with congenital heart diseases. Maternal health is critical particularly during the first trimester [28]. New-born heart health is affected by maternal health during pregnancy and the environmental conditions in which the mother lives. Causes of endomyocardial fibrosis are virus infections and toxic insults among others [29, 30].

It is important to point out that social determinants of health are alluded to in the national development plan 2030 [31]. The realisation and implementation of

**Condition Cause Available interventions**

Poverty, overcrowding, poor sanitary conditions and limited access to health care services

Genes and environmental factors Preventive

Virus infections and toxic insults Preventive

Promotive

Promotive Curative-treatment Rehabilitative

Preventive Promotive

antibiotics Rehabilitative

Curative-medical and surgical treatment Rehabilitative

Curative-treatment with

**8**

**Table 1.**

