African Countries Need Help to Boost CV Research

Despite accounting for nearly 20% of the world’s population, African countries are far behind the rest of the world in leading clinical trials in cardiovascular medicine and need support to boost their research initiatives and pathways, researchers argue.

“It is very clear that we need to improve awareness. These doctors are very talented, they know what needs to be done, but infrastructure needs to be improved to promote research,” senior study author Samir R. Kapadia, MD (Cleveland Clinic Foundation, OH), told TCTMD.

The study, led by Abdelrahman I. Abushouk, MD (Yale School of Medicine, New Haven, CT), found that Egypt, South Africa, and Nigeria were responsible for more than 80% of African-led trials published between 1990 and 2019. Across all 54 African nations, nearly 70% were not involved in any CV trial during the study period.

Cardiology research is losing out on a large, diverse, treatment-naive population that could really advance science. Abdelrahman I. Abushouk

Of the 179 African-led trials that the investigators analyzed, the median number of participants was less than 60, fewer than one-quarter of the efforts were multicenter, and follow-up periods averaged just 12 weeks.

On the upside, the number of African-led trials has increased over time, from just 30 during 2000-2009 to 108 during 2010-2019, the investigators report in a research letter published August 14, 2023, in Circulation: Cardiovascular Quality and Outcomes. “In parallel, African centers have contributed to the implementation of 45 multinational trials in cardiovascular medicine within the same time frame (1990-2019). The most frequent contributor was South Africa (n = 16),” they add.

CV Research ‘Losing Out’ on Untapped Populations

Overall, only about 2,000 cardiologists are practicing throughout the African continent, in contrast to approximately 25,000 in the United States.

Abushouk and colleagues say those small numbers may partly account for the minimal level of African-led clinical trial output in the form of publications, highlighting the need for support to increase training for their researchers so they can focus on population-specific needs.

“Data that we generate from trials here in the US and Europe on the efficacy of drugs or interventions are not necessarily applicable to people in Africa because we know there are genetic, cultural, and economic differences. . . . Meanwhile, the people there are missing from a lot of new drug and device trials,” Abushouk told TCTMD. That is especially harmful, he added, since studies have shown that there may be lag times of as much as 17 years from the time a drug is approved in the US until it gets cleared for use in some African countries.

“A lot of people in Africa are untreated and they would be ideal candidates for research,” he said. “Cardiology research is losing out on a large, diverse, treatment-naive population that could really advance science.”

Money is another obvious obstacle for African nations, limiting their scientists from engaging in CV research, with minimal funding being reported in the 179 trials in the study. Increasing local government spending on clinical research is one option, although Abushouk and colleagues note that it “needs to be balanced against other priorities, such as access to healthcare and public health programs.”

I’m sure it’s not just cardiology, but other specialties as well, that are seeing this as a problem. Samir R. Kapadia

Economic barriers also face individual African researchers seeking to attend international conferences for education and networking purposes. Abushouk, who trained in Egypt, said early in his career a grant from the American College of Cardiology allowed him to present research at a US conference that otherwise would not have been financially feasible.  

“With the economic crises in Africa and in Egypt, specifically with the problem of devaluation of the Egyptian currency, it [is] now impossible for a single cardiologist to pay out of pocket to attend a conference in the United States or in Europe,” added Ahmed Bendary, MD (Benha University, Egypt), a co-author of the study. “This is an additional reason for the barriers between African cardiologists and their colleagues.”

Aside from large organizations offering funding and assistance to African researchers for meeting attendance, Abushouk said he believes individual hospitals and health systems in the US also could provide a needed boost by sponsoring researchers through private fellowships.

“Now with globalization, research should also be globalized and be invested in,” noted Kapadia. “I’m sure it’s not just cardiology, but other specialties as well, that are seeing this as a problem.”