Cardiovascular disease risk factors and socio-economic position of Africans in transition: the THUSA study

In many developing countries with advanced stages of the nutrition transition, the burden of coronary artery disease (CAD) has shifted from the rich to the poor. In South Africa, it is mainly the African population that is experiencing rapid urbanisation and the nutrition transition. It is not clear where the burden of CAD lies in this population group. We tried to answer this question by comparing CAD risk factors within African groups of different socio-economic positions (characterised by total household income and education level) that participated in the THUSA study from 1996 to 1998. The THUSA study was a cross-sectional population- based epidemiological study that examined the influence of urbanisation and related changes in lifestyle and eating patterns on health and disease risk. A total of 1 854 apparently healthy African volunteers were recruited from 37 randomly chosen sites in rural and urban areas of the North-West Province. The results indicated that although the group with the highest socio-economic position had significantly lower serum glucose levels, systolic blood pressures, higher micronutrient intakes and fewer smokers, their sustained increases in total and saturated fat intakes and higher serum total and LDL cholesterol levels, as well as increased body mass indices in men suggested that at that point in time and possibly in the foreseeable future, the burden of CAD will be carried by those Africans with higher socio-economic positions.