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The emergence of cardiovascular disease during urbanisation of Africans

  • HH Vorster (a1)
  • DOI:
  • Published online: 22 December 2006

To review the available data on risk factors for cardiovascular disease (CVD), the influence of urbanisation of Africans on these risk factors, and to examine why stroke emerges as a higher risk than ischaemic heart disease (IHD) in the health transition of black South Africans.


A review of published data on mortality from and risk factors of CVD in South Africans.


South Africa.


South African population groups and communities.


The available data on the contribution of stroke and IHD to CVD mortality in South Africa are briefly reviewed, followed by a comparison of published data on the prevalence and/or levels of CVD risk factors in the different South African population groups. The impact of urbanisation of black South Africans on these risk factors is assessed by comparing rural and urban Africans who participated in the Transition and Health during Urbanisation of South Africans (THUSA) study.

Results and conclusions: The mortality rates from CVD confirmed that stroke is a major public health problem amongst black South Africans, possibly because of an increase in hypertension, obesity, smoking habit and hyperfibrinogenaemia during various stages of urbanisation. The available data further suggest that black South Africans may be protected against IHD because of favourable serum lipid profiles (low cholesterol and high ratios of high-density lipoprotein cholesterol) and low homocysteine values. However, increases in total fat and animal protein intake of affluent black South Africans, who can afford Western diets, are associated with increases in body mass indices of men and women and in total serum cholesterol. These exposures may increase IHD risk in the future.

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7JP Broderick , T Brott , T Tomsick , G Husster , R Miller . The risk of subarachnoid and intercerebral hemorrhaeges in blacks as compared to whites. N. Engl. J. Med. 1992; 326: 733–6.

13JM Van Rooyen , HS Kruger , HW Huisman , MP Wissing , BM Margetts , CS Venter , HH Voerster . An epidemiological study of hypertension and its determinants in a population in transition: the THUSA study. J. Hum. Hyperten. 2000; 14: 779–87.

14S James , HH Vorster , CS Venter , HS Kruger , TA Nell , FJ Veldman , JB Ubbink . Nutritional status influences plasma fibrinogen concentration: evidence from the THUSA survey. Thromb. Res. 2000; 98: 383–94.

16A Loktionov , H Vorster , I O'Neill , T Nell , SA Bingham , SA Runswick , JH Cummings . Apolipoprotein E and methylene tetrahydrofolate reductase genetic polymorphisms in relation to other risk factors for cardiovascular disease in UK Caucasians and black South Africans. Atherosclerosis 1999; 145(1): 125–35.

18HH Vorster , LT Bourne , CS Venter , W Oosthuizen . Contribution of nutrition to the health transition in developing countries: a framework for research and intervention. Nutr. Rev. 1999; 57(11): 341–9.

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