Alarming rise in prevalence of atherogenic dyslipidaemia in the black population of Cape Town: the Cardiovascular Risk in Black South Africans (CRIBSA) study

Abstract

Objectives: To determine the prevalence, determinants, and management of dyslipidaemia in the 25-74-year-old urban black population of Cape Town and examine the changes between 1990 and 2008/09 in the 25-64-year-old sample.

Methods: In 2008/09, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Cardiovascular disease (CVD) risk factors were determined by questionnaires, clinical measurements, and fasting biochemical analyses. Survey logistic regression analysis assessed the determinants of raised low-density lipoprotein cholesterol (LDL-C).

Results: There were 1099 participants in 2008/09 (392 men and 707 women; response rate 86%). The prevalence of raised total cholesterol (TC), raised LDL-C, and reduced high-density lipoprotein cholesterol (HDL-C) were 25.2% (95% confidence interval, CI, 20.0-31.3), 37.8% (95% CI 32.5-43.4), and 55.2% (95% CI 49.9-60.4) in men and 23.1% (95% CI 20.0-26.5), 47.0% (95% CI 43.1-50.9), and 66.8% (95% CI 62.9-70.5) in women, respectively. Between 1990 and 2008/09, raised LDL-C and reduced HDL-C prevalence increased significantly with no change for raised TC. Among participants with raised LDL-C, only 2.6% were aware of their diagnosis, 2.7% were on treatment, and 1.5% had LDL-C <3 mmol/l. In the logistic model, increasing age (odds ratio, OR, 1.04, 95% CI 1.03-1.05; p < 0.001), rising body mass index (OR 1.03, 95% CI 1.01-1.05; p = 0.003), and fat intake ≥30% of diet (OR 1.37, 95% CI 1.02-1.85; p = 0.035) were significantly associated with LDL-C ≥3 mmol/l but not sex, physical activity, or urbanization.

Conclusions: The dyslipidaemia pattern in this population requires full lipogram screening in high-risk individuals and demands improved management using a total CVD risk approach.

Keywords: Black; South Africa; cholesterol; epidemiology; high-density lipoprotein cholesterol; lipid management; lipids; low-density lipoprotein cholesterol; triglycerides; urban.