Different lipid profiles according to ethnicity in the Heart of Soweto study cohort of de novo presentations of heart disease : cardiovascular topics

Abstract

BackgroundHistorically, sub-Saharan Africa has reported low levels of atherosclerotic cardiovascular disease (CVD). However as these populations undergo epidemiological transition, this may change.MethodsThis was an observational cohort study performed at Chris Hani Baragwanath Hospital in Soweto, South Africa. As part of the Heart of Soweto study, a clinical registry captured detailed clinical data on all de novo cases of structural and functional heart disease presenting to the Cardiology unit during the period 2006 to 2008. We examined fasting lipid profiles in 2 182 patients (of 5 328 total cases) according to self-reported ethnicity. The study cohort comprised 1 823 patients of African descent (61% female, aged 56 ± 16 years), 142 white Europeans (36% female, aged 57 ± 13 years), 133 Indians (51% female, aged 59 ± 12 years) and 87 of mixed ancestry (40% female, aged 56 ± 12 years).ResultsConsistent with different patterns in heart disease aetiology, there were clear differences in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides across ethnicities (p < 0.001): patients of African descent had the lowest TC and LDL-C levels and Indians the highest. However, there were no significant differences in high-density lipoprotein cholesterol (HDL-C) levels between ethnicities (p = 0.20). Adjusting for age, gender and body mass index, patients of African descent were significantly less likely to record a TC of > 4.5 mmol/l (OR 0.33, 95% CI: 0.25–0.41) compared to all ethnic groups (all p < 0.001).ConclusionsThese data confirm important blood lipid differentials according to ethnicity in patients diagnosed with heart disease in Soweto, South Africa. Such disparities in CVD risk factors may justify the use of specialised prevention and management protocols.

Ethnic differences in the association between lipid metabolism genes and lipid levels in black and white South African women

“…However, it is more likely that ethnic differences in the relationships between the LPL X and CETP B2 allele and serum lipid levels are due to differences in lifestyle factors between black and white SA women, specifically the intake of dietary fat [6,7,41]. We have previously shown that black women consume more energy, particularly as dietary fat, than white women [26,42,43].…”

“…However in the USA, it has been reported that HDL-C levels are higher in black compared to white women [4,5], whereas in SA, HDL-C levels are similar or lower in black compared to white women [3,6,7]. These observations could explain why black SA women have a lower cholesterol-attributed mortality rate (47 in 100 000) compared to white women (152 in 100 000) [8].…”

Lower BMI cut-off than the World Health Organization-based classification is appropriate for Nigerians

“…Hypertension was equally prevalent among men and women in this population, while hypercholesterolemia was relatively low in this population. This may not be unconnected with the fact that Africans are known to have low cholesterol for genetic reasons (Sliwa et al, 2012;Bentley and Rotimi, 2017). The occurrence of the CVD risk factors in this study increased with age.…”

Protection from Cardiovascular Disease Due to Increased High-Density Lipoprotein Cholesterol in African Black Populations: Myth or Reality?

“…(Table 1) In the Heart of Soweto study, Black African patients had significantly lower total-cholesterol, LDLcholesterol and triglycerides compared with Indian, White and mixed ethnic groups; however, HDL-C did not differ between ethnic groups. 6 Similarly in 2001, Punyadeera et al showed that South African White women presented with higher total cholesterol, triglycerides and LDLcholesterol concentrations than Black women, but HDL-C concentrations did not differ by ethnicity. tions than matched African diabetic patients, most likely due to access to statin therapy, which is available in more developed countries.…”

“…[1][2][3] Progressive changes in socioeconomic status and a Westernized lifestyle contribute to the burden of preventable CVD. [4][5][6] Since first demonstrated in the Framingham Heart study, it is now generally accepted that high-density lipoprotein cholesterol levels (HDL-C) are inversely correlated with CVD risk. [7][8][9] Much of the benefits of HDL are thought to be related to its antiatherogenic functions including reverse cholesterol efflux, anti-oxidative, anti-inflammatory and anti-thrombotic properties.…”