부산대학교 도서관

Background: The burden of cardiometabolic disease (CMD) is rising in sub-Saharan Africa (SSA). However, there are limited population-based prevalence estimates of CMD risk factors to inform public health initiatives for the prevention and management of CMDs in these populations. This thesis aims to contribute to this evidence gap by assessing the prevalence and distribution of established and emerging CMD risk factors, associations between risk factors, and tools for their identification, in a South African population. Methods: The Durban Diabetes Study (DDS), a population-based cross-sectional survey of CMD risk factors, was designed and data were collected on 1204 participants from the eThekwini Municipality, South Africa. Key findings: In this urban South African population, the prevalence of most CMD risk factors was high, and varied across demographic and socioeconomic groups. The prevalence of smoking and alcohol consumption was higher in men, whilst the prevalence of obesity, hypertension, dyslipidaemia, and hyperglycaemia was higher in women. Wealth was associated with obesity and hypercholesterolemia, whilst education level and employment status were associated with smoking, physical activity and diabetes. Despite several potential advantages, the use of glycated haemoglobin (HbA1c) for diagnosis of diabetes is not established in SSA. Using plasma glucose measures as the reference, HbA1c ≥6.5% detected diabetes with high sensitivity and specificity. Furthermore, the association of anaemia, HIV, and antiretroviral therapy (ART) with HbA1c was modest and no statistically significant differences in the prevalence of diabetes were found in those with anaemia or HIV based on plasma glucose and HbA1c measurements. This is the first evidence for the utility of HbA1c for the diagnosis of diabetes in a black SSA population. There is emerging evidence for the association of HIV and ART with CMD risk factors. In the DDS, the prevalence of HIV was high (43.5%) and untreated HIV was associated with low high-density lipoprotein cholesterol, whilst ART-treated HIV was associated with high triglycerides. Finally, 30.8% of participants were at high risk of CMD based on metabolic syndrome, but only 7.9% had high 10-year cardiovascular disease risk based on the Framingham risk score. Conclusion: This thesis has added to the evidence base on CMD risk factors in South Africa. These findings highlight the need for longitudinal studies to investigate the aetiology of CMDs and robustly assess the utility of tools to identify risk of CMD in SSA populations.