Awareness, treatment, and control of dyslipidemia in rural South Africa: The HAALSI (Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa) study

Abstract

Dyslipidemia is a primary driver for chronic cardiovascular conditions and there is no comprehensive literature about its management in South Africa. The objective of this study was to assess the prevalence, awareness, treatment, and control of dyslipidemia in rural South Africa and how they are impacted by different behaviors and non-modifiable factors. To fulfill this objective we recruited for this cohort study adults aged ≥40 years residing in the Agincourt sub-district of Mpumalanga Province. Data collection included socioeconomic and clinical data, anthropometric measures, blood pressure (BP), HIV-status, point-of-care glucose and lipid levels. Framingham CVD Risk Score was ascribed to patients based upon categories for 10 year cardiovascular risk of low (<3%), moderate (≥3% and <15%), high (≥15% and <30%), and very high (≥30%).LDL cholesterol control by risk category was defined according to South African Guidelines. Multivariable logistic regression models were built to identify factors that were significantly associated with dyslipidemia and awareness of dyslipidemia From 5,059 respondents a total of 4247 subjects (83.9%) had their cholesterol levels measured and were included in our analysis. Overall, 67.3% (2860) of these met criteria for dyslipidemia, only 30 (1.05%) were aware of their condition, and only 21 subjects (0.73%) were on treatment. The majority have abnormalities in triglycerides (59.3%). As cardiovascular risk increased the rates of lipid control according to LDL level dropped. Multivariate logistic regression analyses showed that being overweight was predictive of dyslipidemia (OR 1.76; 95%CI 1.51–2.05, p<0.001) and dyslipidemia awareness (OR 2.58; 95%CI 1.19–5.58; p = 0.017). In conclusion, the very low awareness and treatment of dyslipidemia in this cohort indicate a greater need for systematic screening and education within the population and demonstrate that there are multiple opportunities to allay this burden.

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“…In our study, we recruited 20-70 years old people, while the national STEPs survey included Mongolians between 15-64 years of age. Our 68.7% prevalence of dyslipidemia is as high as in rural South Africa (67.3%) [15] and Luxembourg (69.9%) [16], while the prevalence in Canada, China, USA, Kazakhstan and Malaysia was 40% [11], 41.9% [13] 53% [17], 37.0% [18] and 47.7% [19] respectively.…”

Awareness, treatment, control, and determinants of dyslipidemia among adults in China: results from the China National Stroke Screening and Prevention Project (CNSSPP)

“…This was consistent with an earlier study. 44 Speculatively, the low awareness level seen could be due to the natural history of the disease, or one's poor attitude towards healthcare. Overweight and general obesity were signi cant negative predictor for dyslipidemia control, these were similar to earlier researches.…”

Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa

“…Another study found disparities by age and sex in the control of cardiovascular disease risk factors such as tobacco use, high blood pressure, elevated body mass index, low-density lipoprotein, and waist-to-hip ratio (Jardim et al 2017). High rates of dyslipidemia and low awareness were also found in the baseline study (Reiger et al 2017.…”