The rarity of coronary heart disease in South African blacks
Insights
Coronary heart disease (CHD) is rare in South African Black populations, contrary to expectations given their exposure to risk factors. This rarity is appropriate to their environmental circumstances, not an enigma.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Coronary heart disease (CHD) is unusually uncommon in South African Black individuals.
- This observation presents an enigma, as this population is thought to be exposed to conventional CHD risk factors.
Purpose of the Study:
- To investigate the exposure of South African Black individuals to established coronary heart disease risk factors.
- To determine if the low incidence of CHD in this population is indeed enigmatic or explainable by their environment.
Main Methods:
- Assessment of exposure to risk factors including affluence, age, hypertension, hyperlipidaemia, diet, smoking, physical activity, diabetes, obesity, hyperuricaemia, and hyperinsulinism.
- Analysis of risk factor prevalence in South African Black males and females.
Main Results:
- Hypertension was identified as a prominent risk factor in males.
- Hypertension and obesity were prominent in females.
- Neither hypertension nor obesity were found to be significantly atherogenic within the social, nutritional, and metabolic context of the Black South African population.
Conclusions:
- The low incidence of coronary heart disease in South African Black individuals is not enigmatic.
- The rarity of CHD is consistent with their specific environmental circumstances and metabolic milieu.
Abstract:
Coronary heart disease (CHD) remains an uncommon disorder in the South African Black population. It has been suggested that herein lies an enigma, since it is believed that these people are considerably exposed to the conventional risk factors for CHD. To test this belief I have assessed the exposure of Black people, in time and degree, to the following CHD risk factors: affluence, age, hypertension, hyperlipidaemia, dietary excess, smoking, physical inactivity, diabetes, obesity, hyperuricaemia and hyperinsulinism. Among males only hypertension, and among females only hypertension and obesity, emerged as prominent factors. However, neither of these is significantly atherogenic in the social, nutritional and metabolic milieu in which Blacks generally live, and obesity is a doubtful atherogenic factor, even in westernized populations. It is therefore concluded that the rarity of CHD in Blacks is not enigmatic, but is appropriate to their environmental circumstances.
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