Clinical cardiovascular research primarily is conducted in high-income countries where highly sophisticated medical care is widely available. We have little data on disease patterns and outcomes in low and middle-income countries (LMIC) where medical resources often are limited. In the Editor's choice in this issue of Heart, Professor Sliwa and colleagues (see page 1967) present a prospective cohort study of 225 pregnant women with cardiovascular disease seen at a single center in South Africa. In high risk women, 32% had congenital heart disease, 26% valvular disease and 27% had a cardiomyopathy. In contrast to higher-income countries where congenital heart disease is the primary concern, in this cohort rheumatic valve disease, hypertensive heart disease and cardiomyopathy were more common; often complicated by comorbid HIV/AIDS. In the 152 women who had cardiovascular symptoms, 6% died within 6 months, with most deaths occurring more than 6 weeks post-partum. The perinatal infant mortality rate was 7 per 1000 live births.

In an editorial, Professors Ribeiro and Freire (see page 1901) comment that further studies on the clinical disease spectrum and outcomes of cardiovascular disease in LMICs are needed. However, they caution that “although LMICs have been frequently treated as a group, they …