Hypercholesterolaemia in the coloured population of the Cape Peninsula (CRISIC study)

A cross-sectional study of hypercholesterolaemia in a random sample of 976 subjects showed that hypercholesterolaemia was common in a coloured population. Of the males 17.4% and of the females 16.2% had total serum cholesterol values above 6.5 mmol/l. Using a cut-off point of 5.7 mmol/l the age-standardised prevalence of hypercholesterolaemia was 34.5% for males and 32.9% for females. Age- and sex-specific cut-off points showed that 69.2% of males and 65.9% of females were at risk for coronary heart disease (CHD) by virtue of the total cholesterol level. Of the males 19.1% and of the females 13.4% warranted investigation for possible familial hypercholesterolaemia. A protective high-density lipoprotein cholesterol/total cholesterol ratio was found in 61.2% of males and 51.9% of females. Hypercholesterolaemia was statistically significantly associated with a reported history and a familial history of CHD as well as with hypertension and diabetes in some groups studied. Unlike most cross-sectional studies this study showed that hypercholesterolaemic participants consumed more saturated fat and their diets had a higher Keys score than did normocholesterolaemic participants. Only 16.5% of males and 21.7% of females had modified their diets to prevent heart disease. High levels of total cholesterol were found to be associated with high levels of serum triglycerides and uric acid, high body mass index, high diastolic and systolic blood pressure and higher socio-economic standing. An education programme to initiate the dietary modifications that lead to the lowering of serum cholesterol levels is necessary to reduce CHD in the coloured population.     

The coexistence of major coronary heart disease risk factors in the coloured population of the Cape Peninsula (CRISIC study)

A cross-sectional study of risk factors for coronary heart disease in a random sample of 976 people from a South African coloured population revealed this group to be at great risk. The prevalences of individual and of coexisting reversible risk factors--hypercholesterolaemia, hypertension and smoking--were highest in the older subjects, who use medical services more often. One or more of the three risk factors was present in 80% of men aged 45 years or over. Smoking was the most common single risk factor for both sexes, and almost 30% of women aged 45 years or over were hypertensive. Hypertension and smoking was the most common combination for males and hypertension and hypercholesterolaemia the most common for females. Medical personnel could identify and treat these very-high-risk patients if they were to screen for all the risk factors after identifying any one risk factor. Younger people at risk and particularly younger men, who rarely utilise health services, should be reached at their workplace for early identification of risk factors.     

Hypertension in the coloured population of the Cape Peninsula

In a random sample of 976 coloured people 17.2% of men and 18.4% of women were hypertensive (greater than or equal to 160/95 mmHg or receiving medication). In the same population 35.6% of men and 24.7% of women suffered from total hypertension (greater than or equal to 140/90 mmHg). Men between 25 and 44 years had a markedly higher prevalence of hypertension than women of the same age. Above this age the situation was reversed. Correcting for under- and over-cuffing increased the mean pressures in men and decreased them in older women. Only 42.2% of hypertensive men and 69.9% of women were aware of their condition. Only 41.3% were on medication for it and a mere 16% had blood pressures below 160/95 mmHg. Hypertensives had significantly lower intakes of potassium, calcium, magnesium and saturated fat than normotensive subjects. Young hypertensives consumed more salt than older hypertensives. Both systolic and diastolic blood pressures were positively associated with alcohol consumption, smoking (in men), total serum cholesterol, low-density lipoprotein cholesterol, non-fasting triglyceride and uric acid levels. Hypertensive subjects were less educated and showed more type A coronary-prone behaviour than normotensives. A comparison of the prevalence of hypertension in the four South African ethnic groups is given.     

Anthropometric profile of the coloured population of the Cape Peninsula

Study of a sample of 976 randomly selected coloured persons 15-64 years of age living in the Cape Peninsula included measurement of height, weight and mid-arm circumference and calculation of the body mass index (BMI). The mean height of the men was 167.6 cm and that of the women 156 cm. Mean weight, BMI and mid-arm circumference for men were 65.9 kg, 23.4 and 27.5 cm respectively and those for women 65.8 kg, 27.1 and 28.9 cm respectively. The prevalence of underweight for men (BMI less than 20) was 23.6% and for women (BMI less than 19) 9.8%; 17.7% of men were overweight (BMI greater than or equal to 25) and 3.7% obese (BMI greater than or equal to 30), while 35.2% of women were overweight (BMI greater than or equal to 24) and 18.8% obese. Overweight and obesity were more common among the older coloured women than among a group of South African white women of the same age. Obese women in the age group 35-44 years were 4.8 times more likely to be hypertensive than women of normal weight in the same age group (odds ratio; 95% confidence interval 2.2-4). Older women did not show this association. There were too few obese men to analyse in this manner. Many of the obese participants did not see themselves as obese. Only 19.7% of men and 45.2% of women had attempted to lose weight during the year preceding the study, in many cases using methods known to be ineffective. The coloureds of the Cape Peninsula were found to be a population with shorter stature than South African white and American populations. Some young participants of both sexes and some older men were underweight, while among older women there was a high prevalence of overweight and obesity. The findings may suggest previous undernutrition in both sexes, with a marked tendency to current overnutrition in adult females.     

Coronary risk factors in the coloured population of the Cape Peninsula

A cross-sectional study of risk factors for coronary heart disease (CHD) in a random sample of 976 coloured people revealed a population greatly at risk of CHD. The major reversible risk factors--hypercholesterolaemia, hypertension and smoking--were very common, with 56% of the men and 40% of the women smoking, 18% of both men and women being hypertensive and 17% of both sexes being hypercholesterolaemic. At high cut-off points 62,8% of the men and 59,4% of the women had at least one major reversible risk factor. At lower but real levels of risk, over 80% of the population was affected. Other risk factors such as inactivity, overweight, hyperuricaemia, hypertriglyceridaemia and a positive family history of CHD were all common in this population group. A 'protective' high-density lipoprotein cholesterol level of greater than or equal to 20% of the total serum cholesterol level was found in 74,5% of the men and 81,1% of the women. A comparison with available data on other South African population risk profiles shows marked differences. The need for preventive strategies in the coloured population is clear.     

Health actions and disease patterns related to coronary heart disease in the coloured population of the Cape Peninsula

The health-related behaviour of the Cape Peninsula coloured population, which has been shown to have an adverse coronary heart disease (CHD) risk factor profile, is reported. Private medical services were used most often by participants: 54.1% and 51.6% of males and females respectively had made use of these services during the preceding year. Only 17.9% and 21.8% of males and females respectively had attended day hospitals during the year. Blood pressures were measured in 43.8% and 57.1% of male and female participants respectively during the year preceding the study. The results indicated the need for the measurement of blood pressure to determine the true prevalence of hypertension, since patient reporting of the condition was inaccurate. Attempts to give up smoking had been made by 44.4% of male and 47.1% of female smokers. About 75% of the participants were found to have hypercholesterolaemia, yet their knowledge of the prudent diet was poor and few reported appropriate dietary modifications to protect against CHD. Frequent reporting of hypercholesterolaemia, hypertension and constipation by the study population highlights the need for dietary education. Mortality rates (MRs) for CHD and cerebrovascular disease (CVD) for the coloured and the white populations were compared. In all age groups white males had higher MRs for CHD than coloured males, while coloured females older than 34 years had higher rates than their white counterparts. The coloured population had MRs for CVD that were higher than those of whites.     

Relationship between coronary-prone (type A) behaviour and other coronary risk factors in the coloured population of the Cape Peninsula

In this investigation, conducted among 976 adult coloureds living in the Cape Peninsula, emphasis was placed on the relationship between type A (coronary-prone) behaviour and a number of other coronary risk factors (hypertension, hypercholesterolaemia, overweight and cigarette smoking), as well as certain demographic variables (age, occupational group and level of education). There was a fairly even distribution between high and low type A behaviour scores for both sexes in the groups aged 15 - 54 years, whereas there were proportionally fewer high than low scores in people between 55 and 64 years old. Housewives generally had lower scores than working women and other women who were not economically active. Both male and female respondents with high type A scores recorded on average higher systolic blood pressure readings. Type A men also smoked more than others. It appears that type A behaviour is mainly independent of other coronary risk factors.     

The relationship between dietary factors and serum cholesterol values in the coloured population of the Cape Peninsula

A cross-sectional study of 976 coloured subjects aged 15-64 years identified a population consuming a typical Western diet. Nutrient intake, determined by the 24-hour dietary recall method, reflected a diet high in fat (37% of total energy intake) and animal protein and a polyunsaturated/saturated fatty acid ratio of 0.85. Only 32.2% of men and 27.5% of women consumed a prudent diet (Keys score less than or equal to 28). The influence of this Western diet on serum total cholesterol (TC) levels was seen to be marked when participants with a high risk of developing coronary heart disease (CHD) were compared with those with a TC level putting them at low risk; the former consumed significantly more saturated fat and had a higher mean Keys score. Multiple linear regression analysis on TC levels of men identified six variables that explained 26.9% of the variation of TC. These were body mass index, age, the inverse of the polyunsaturated fat intake, saturated fat intake, polyunsaturated/saturated fat ratio and cholesterol intake. For women only three variables (age, the inverse of the polyunsaturated/saturated fat ratio, and body mass index) explained 30.2% of the variation of TC. Promotion of the prudent diet to lower TC levels of the coloured population of the Cape Peninsula is an increasingly urgent priority.     

Requirements of a coronary heart disease risk factor intervention programme for the coloured population of the Cape Peninsula

The coloured population of the Cape Peninsula has been identified as having a high prevalence of risk factors for coronary heart disease (CHD), notably hypertension, cigarette smoking and hypercholesterolaemia. The need for an appropriate and effective CHD intervention programme, directed at the population as a whole, has become urgent. Three central problem areas relating to hypertension control--diagnosis, management and compliance--will have to be addressed. Hypertension was underdiagnosed among men, particularly those aged 25-44 years. Apart from educating this group regarding the need to have their blood pressure measured, detection programmes are therefore needed at the workplace to improve hypertension diagnosis. Inadequate management of hypertension was commonest in women aged over 45 years. Compliance with hypertension treatment regimens was poor in all men as well as in both sexes belonging to the lower socio-economic strata. Establishing easily accessible blood pressure stations for monitoring blood pressure and educating hypertensives regarding their condition could lead to improved management and compliance. Coloureds were found to smoke heavily, and the women had the highest smoking prevalence of all South African women. Furthermore, the age of onset of smoking is decreasing among coloured children. A general anti-smoking campaign directed at all South Africans is necessary to control smoking. Anti-smoking education programmes at primary school level are of particular importance to prevent the onset of the habit. More than 70% of coloureds had a serum cholesterol level imparting CHD risk, few followed a prudent diet and their knowledge of the prudent diet was poor. Health education programmes to promote the prudent diet are required.(ABSTRACT TRUNCATED AT 250 WORDS)     

The prevalence of locomotor disability and handicap in the Cape Peninsula. Part I. The coloured population of Bishop Lavis

A door-to-door survey to identify the locomotor disabled was carried out on 33.35% of the so-called coloured population in a low socio-economic area of the Cape Peninsula (9112 people). The prevalence rate of locomotor disability was 11.2/1000. The main causes of disability were illness (44.1%) and trauma (41.2%); the former resulted mostly from cerebrovascular accidents (15.7%) and poliomyelitis (15.7%). Of the disabled persons 11.8% were 15 years of age or less, 57.8% between the ages of 16 and 59 years and 30.4% were more than 60 years. Of those in the working-age group 15% were employed. Few of the unemployed had hobbies or interests or had any contact with health or social services.     

Hypertension management in a Cape Peninsula coloured community. A retrospective medium-term assessment

A retrospective study of the records of a large hypertension clinic at a primary care centre was carried out for the period 1975-1984. A total of 250 patients were selected from a systemic 1-in-2 sample. The objectives were to establish the degree of control, compare the use of a large arm blood pressure (BP) cuff with a standard one, and determine the prevalence of associated diseases and the cost of drug therapy. The mean systolic BP was 163.2 mmHg, with 45% of patients having a systolic BP below 160 mmHg. The mean diastolic BP was 101.2 mmHg with 13% of patients having a diastolic BP below 95 mmHg. The majority of patients were overweight and the large BP cuff was found to be useful.     

Smoking practices in the black township population of Cape Town

A smoking prevalence survey was conducted in the black township population of Cape Town in order to assist with the planning of an anti-smoking campaign. Three townships were selected to reflect different levels of urbanisation: Langa (a settled urban community), Site B (a population of recent arrivals in the urban environment) and Khayelitsha (of intermediate urban status). Using World Health Organisation guidelines a school survey and an adult survey were conducted in each area. Of the 673 school pupils who were interviewed, 0.8% of girls and 23.7% of boys were current smokers. There was a trend to increasing smoking prevalence with increasing age among boys. After age-adjustment there was no difference in smoking prevalence between boys at the three schools. Information from 1320 adult respondents and 1,401 proxy-reported adults yielded an overall smoking prevalence of 7% (95% confidence interval 5.6-8.4%) for women and 60% (95% confidence intervals 57.5-62.5%) for men. Two-thirds of male smokers were smoking 10 or more cigarettes per day. The preferred mode of tobacco consumption in 87% of adults and 91% of school pupils was manufactured cigarettes. The survey has established three target groups for intervention in the black townships of Cape Town: boys in their early teens for prevention of initiation of smoking; adult men for assistance with smoking cessation; and girls and women to maintain their non-smoking status.     

Risk factors for coronary heart disease in the black population of the Cape Peninsula. The BRISK study

A cross-sectional study of risk factors for ischaemic heart disease (IHD) in a random sample of 986 black people aged 15-64 years living in the Cape Peninsula revealed a population at lower risk for IHD than other South Africans. Blood pressures of 140/95 mmHg or above were found in 14.4% of males and 13.7% of females. Fifty-two per cent of males and 8.4% of females smoked, while 16.5% of males and 25.8% of females had a total cholesterol (TC) level imparting risk for developing IHD. In this population the TC level is not a good surrogate measure for low-density lipoprotein cholesterol because of the high level of high-density lipoprotein cholesterol (HDLC) found in this population. A protective HDLC/TC ratio of 20% was found in 96% of males and 96.1% of females. When considering the three major reversible IHD risk factors at a high level of risk, 30.8% of males and 12.5% of females had at least one such a risk factor. The population was frequently exposed to the media, with 80% listening to the radio every day and 55% watching television at least once a week. This suggests that a healthy lifestyle could be promoted successfully by means of these media. In addition, schools should promote a healthy lifestyle and the prevention of chronic degenerative diseases should be incorporated into the evolving primary health care services in South Africa.     

Growth of preschool coloured children in Cape Town

The growth of a random sample of coloured children in Cape Town was studied from birth until 5 years. At birth they were relatively light and short for gestational age. Size at birth correlated with social class. A rapid postnatal weight gain rendered them relatively overweight between 3 and 6 months. Thereafter they became lighter and shorter than the NCHS reference values and this persisted throughout the preschool period. Genetic factors, reflected by parental growth, were found to predict growth during childhood, but they were more predictive of weight and head circumference than of length. From 12 months onwards, socio-economic factors played a significant role in determining growth even after the effects of the genetic factors had been taken into account.     

Preschool development of coloured children in Cape Town

Developmental screening was applied during infancy to a birth cohort of 1,000 coloured infants born consecutively in Cape Town. The developmental progress of a sample of 187 children randomly selected from the cohort was followed over a period of 5 years. The value of the use of developmental screening is questioned, since 4 of the children in the cohort with major handicap had been diagnosed before the first screening was carried out and a 5th child with deafness was not detected by the screening process. Developmental milestones were similar to those studies reported in the literature. At 12 months the development correlated best with family stability. Language development at 30 months was associated with mother's education and family stability and reflected a general lag in verbal skills. By 5 years there was a good correlation between development and social indicators, particularly income and mother's education.     

Gaucher's disease in the Cape coloured population of the RSA, including a family with 5 affected siblings

Nine Cape Coloured children from 4 families with severe non-neuropathic Gaucher's disease are documented. The diagnosis was confirmed histologically in the bone marrow, spleen and liver, and by serum acid phosphatase and leucocyte beta-glucosidase assays. This represents a minimum prevalence for Gaucher's disease of 1 in 247,350 in this population and an approximate genetic carrier rate of 1 in 230 for the abnormal gene. A family with 5 affected siblings is recorded. The severe early clinical expression documented in these coloured patients is similar to that described in the Afrikaner population and differs from the less severe expression of Gaucher's disease in the South African Ashkenazi Jewish population. Gaucher's disease in the Cape Coloured population presents with a precocious onset, causes severe complications and progresses rapidly.