Asiki Gershim, Murphy Georgina A V, Baisley Kathy, Nsubuga Rebecca N, Karabarinde Alex, Newton Robert, Seeley Janet, Young Elizabeth H, Kamali Anatoli, Sandhu Manjinder S
Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda.
Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
PLoS One. 2015 May 14;10(5):e0126166. doi: 10.1371/journal.pone.0126166. eCollection 2015.
The burden of dyslipidaemia is rising in many low income countries. However, there are few data on the prevalence of, or risk factors for, dyslipidaemia in Africa.
In 2011, we used the WHO Stepwise approach to collect cardiovascular risk data within a general population cohort in rural south-western Uganda. Dyslipidaemia was defined by high total cholesterol (TC) ≥ 5.2 mmol/L or low high density lipoprotein cholesterol (HDL-C) <1 mmol/L in men, and <1.3 mmol/L in women. Logistic regression was used to explore correlates of dyslipidaemia.
Low HDL-C prevalence was 71.3% and high TC was 6.0%. In multivariate analysis, factors independently associated with low HDL-C among both men and women were: decreasing age, tribe (prevalence highest among Rwandese tribe), lower education, alcohol consumption (comparing current drinkers to never drinkers: men adjusted (a)OR=0.44, 95%CI=0.35-0.55; women aOR=0.51, 95%CI=0.41-0.64), consuming <5 servings of fruit/vegetable per day, daily vigorous physical activity (comparing those with none vs those with 5 days a week: men aOR=0.83 95%CI=0.67-1.02; women aOR=0.76, 95%CI=0.55-0.99), blood pressure (comparing those with hypertension to those with normal blood pressure: men aOR=0.57, 95%CI=0.43-0.75; women aOR=0.69, 95%CI=0.52-0.93) and HIV infection (HIV infected without ART vs. HIV negative: men aOR=2.45, 95%CI=1.53-3.94; women aOR=1.88, 95%CI=1.19-2.97). The odds of low HDL-C was also higher among men with high BMI or HbA1c ≤ 6%, and women who were single or with abdominal obesity. Among both men and women, high TC was independently associated with increasing age, non-Rwandese tribe, high waist circumference (men aOR=5.70, 95%CI=1.97-16.49; women aOR=1.58, 95%CI=1.10-2.28), hypertension (men aOR=3.49, 95%CI=1.74-7.00; women aOR=1.47, 95%CI=0.96-2.23) and HbA1c >6% (men aOR=3.00, 95%CI=1.37-6.59; women aOR=2.74, 95%CI=1.77-4.27). The odds of high TC was also higher among married men, and women with higher education or high BMI.
Low HDL-C prevalence in this relatively young rural population is high whereas high TC prevalence is low. The consequences of dyslipidaemia in African populations remain unclear and prospective follow-up is required.
在许多低收入国家，血脂异常的负担正在上升。然而，关于非洲血脂异常的患病率或危险因素的数据很少。
2011年，我们采用世界卫生组织的逐步方法，在乌干达西南部农村的普通人群队列中收集心血管风险数据。血脂异常的定义为：男性总胆固醇（TC）≥5.2 mmol/L或高密度脂蛋白胆固醇（HDL-C）<1 mmol/L，女性HDL-C<1.3 mmol/L。采用逻辑回归分析血脂异常的相关因素。
HDL-C降低的患病率为71.3%，高TC的患病率为6.0%。在多变量分析中，男性和女性中与HDL-C降低独立相关的因素包括：年龄下降、部落（卢旺达部落患病率最高）、教育程度较低、饮酒（将当前饮酒者与从不饮酒者比较：男性调整后比值比（a）OR=0.44，9５%置信区间（CI）=0.35-0.55；女性aOR=0.51，95%CI=0.41-0.64）、每天食用水果/蔬菜少于5份、日常剧烈体育活动（将无体育活动者与每周进行5天体育活动者比较：男性aOR=0.83，95%CI=0.67-1.02；女性aOR=0.76，95%CI=0.55-0.99）、血压（将高血压患者与血压正常者比较：男性aOR=0.57，95%CI=0.43-0.75；女性aOR=0.69，95%CI=0.52-0.93）和HIV感染（未接受抗逆转录病毒治疗的HIV感染者与HIV阴性者比较：男性aOR=2.45，95%CI=1.53-3.94；女性aOR=1.88，95%CI=1.19-2.97）。BMI高或糖化血红蛋白（HbA1c）≤6%的男性以及单身或有腹型肥胖的女性中HDL-C降低的几率也更高。在男性和女性中，高TC与年龄增加、非卢旺达部落、腰围增加（男性aOR=5.70，95%CI=1.97-16.49；女性aOR=1.58，95%CI=1.10-2.28）、高血压（男性aOR=3.49，95%CI=1.74-7.00；女性aOR=1.47，95%CI=0.96-2.23）和HbA1c>6%（男性aOR=3.00，95%CI=1.37-6.59；女性aOR=2.74，95%CI=1.77-4.27）独立相关。已婚男性以及教育程度较高或BMI高的女性中高TC的几率也更高。
在这个相对年轻的农村人群中，HDL-C降低的患病率较高，而高TC的患病率较低。非洲人群血脂异常的后果仍不清楚，需要进行前瞻性随访。
