The emergence of cardiovascular disease during urbanisation of Africans

Area of Science:

• Cardiovascular disease epidemiology
• Public health in South Africa
• Health transition studies

Background:

• Cardiovascular disease (CVD) poses a growing threat in South Africa.
• Urbanization significantly impacts health behaviors and disease risk profiles.
• Understanding specific CVD risks like stroke versus ischemic heart disease (IHD) is crucial for targeted interventions.

Purpose of the Study:

• To review cardiovascular disease (CVD) risk factors in South Africans.
• To analyze the influence of urbanization on CVD risk factors among Africans.
• To investigate the higher incidence of stroke compared to ischemic heart disease (IHD) in black South Africans during their health transition.

Main Methods:

• A comprehensive review of published data on CVD mortality and risk factors in South Africa.
• Comparison of CVD risk factor prevalence across different South African population groups.
• Assessment of urbanization's impact on black South Africans' CVD risk factors using the THUSA study data.

Main Results:

• Stroke is a major public health problem for black South Africans, associated with increased hypertension, obesity, smoking, and hyperfibrinogenemia during urbanization.
• Black South Africans appear protected against IHD due to favorable serum lipid profiles and low homocysteine levels.
• Increased intake of Western diets among affluent black South Africans correlates with higher body mass indices and serum cholesterol, potentially elevating future IHD risk.

Conclusions:

• Stroke represents a significant and growing public health challenge in black South African populations.
• While potentially protected against IHD, lifestyle shifts associated with Westernized diets may increase future cardiovascular risk.
• Public health strategies must address the distinct and evolving CVD risk profiles within South Africa's diverse population groups.