Prevalence of dyslipidaemia and associated risk factors in a rural population in South-Western Uganda: a community based survey.

Gershim Asiki,Janet Seeley,Georgina A V Murphy,Kathy Baisley,Elizabeth H Young,Alex Karabarinde,Rebecca N Nsubuga,Manjinder S Sandhu,Robert Newton,Anatoli Kamali

doi:10.1371/journal.pone.0126166

Abstract

BackgroundThe 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.MethodsIn 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) ≥ 5.2mmol/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.ResultsLow 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.ConclusionLow 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.

Highlights

Dyslipidaemia is a major modifiable risk factor for cardiovascular disease accounting for an estimated 4 million deaths per year worldwide. [1] The INTERHEART study showed that dyslipidaemia is the leading population level risk factor for ischaemic heart disease in Africa. [2] Age-standardized mortality from cardiovascular diseases for countries in sub-Saharan Africa, including Uganda, is estimated to be at least three-fold higher than in several European countries, in part because of inadequate access to preventive interventions and treatment.[3]
Dyslipidaemia was defined by high total cholesterol (TC) 5.2mmol/L or low high density lipoprotein cholesterol (HDL-C)
A few studies of dyslipidaemia in Uganda have shown a high prevalence among urban city residents, among patients with diabetes and HIV patients receiving highly active antiretroviral therapy (HAART). [9,10,11] Most population based studies use total cholesterol (TC) to define dyslipidaemia because it is a good surrogate marker for Low density lipoprotein cholesterol (LDL-C)