Thorogood Margaret, Connor Myles, Tollman Stephen, Lewando Hundt Gillian, Fowkes Gerry, Marsh Jennifer
University of Warwick, Coventry, UK.
BMC Public Health. 2007 Nov 13;7:326. doi: 10.1186/1471-2458-7-326.
Rural sub-Saharan Africa is at an early stage of economic and health transition. It is predicted that the 21st century will see a serious added economic burden from non-communicable disease including vascular disease in low-income countries as they progress through the transition. The stage of vascular disease in a population is thought to result from the prevalence of vascular risk factors. Already hypertension and stroke are common in adults in sub-Saharan Africa. Using a multidisciplinary approach we aimed to assess the prevalence of several vascular risk factors in Agincourt, a rural demographic surveillance site in South Africa.
We performed a cross sectional random sample survey of adults aged over 35 in Agincourt (population approximately 70 000). Participants were visited at home by a trained nurse who administered a questionnaire, carried out clinical measurements and took a blood sample. From this we assessed participants' history of vascular risk, blood pressure using an OMRON 705 CP monitor, waist circumference, body mass index (BMI), ankle brachial index (ABI), and total and HDL cholesterol.
402 people (24% men) participated. There was a high prevalence of smoking in men, but the number of cigarettes smoked was small. There was a striking difference in mean BMI between men and women (22.8 kg/m2 versus 27.2 kg/m2), but levels of blood pressure were very similar. 43% of participants had a blood pressure greater than 140/90 or were on anti-hypertensive treatment and 37% of participants identified with measured high blood pressure were on pharmacological treatment. 12% of participants had an ABI of < 0.9, sugesting the presence of sub-clinical atheroma. 25.6% of participants had a total cholesterol level > 5 mmol/l.
We found a high prevalence of hypertension, obesity in women, and a suggestion of subclinical atheroma despite relatively favourable cholesterol levels in a rural South African population. South Africa is facing the challenge of an emerging epidemic of vascular disease. Research to establish the social determinates of these risk factors and interventions to reduce both individual and population risk are required.
撒哈拉以南非洲农村地区正处于经济和健康转型的早期阶段。据预测，随着低收入国家在转型过程中不断发展，21世纪非传染性疾病（包括血管疾病）将给它们带来严重的额外经济负担。人们认为，人群中血管疾病的阶段是由血管危险因素的流行率决定的。高血压和中风在撒哈拉以南非洲的成年人中已经很常见。我们采用多学科方法，旨在评估南非农村人口监测点阿金库尔几种血管危险因素的流行率。
我们对阿金库尔年龄超过35岁的成年人进行了横断面随机抽样调查（人口约7万）。由一名经过培训的护士到参与者家中进行访问，该护士发放问卷、进行临床测量并采集血样。据此，我们评估了参与者的血管危险因素病史、使用欧姆龙705 CP监测仪测量的血压、腰围、体重指数（BMI）、踝臂指数（ABI）以及总胆固醇和高密度脂蛋白胆固醇水平。
402人（24%为男性）参与了调查。男性吸烟率很高，但吸烟量较少。男性和女性的平均BMI存在显著差异（分别为22.8kg/m²和27.2kg/m²），但血压水平非常相似。43%的参与者血压高于140/90或正在接受抗高血压治疗，在经测量确诊为高血压的参与者中，37%正在接受药物治疗。12%的参与者ABI<0.9，提示存在亚临床动脉粥样硬化。25.6%的参与者总胆固醇水平>5mmol/L。
我们发现，尽管南非农村人口的胆固醇水平相对良好，但高血压、女性肥胖以及亚临床动脉粥样硬化的迹象仍然普遍存在。南非正面临血管疾病新兴流行的挑战。需要开展研究以确定这些危险因素的社会决定因素，并采取干预措施降低个体和人群风险。
