Estimating the burden of disease attributable to high cholesterol in South Africa in 2000.

OBJECTIVES: To estimate the burden of disease attributable to high cholesterol in adults aged 30 years and older in South Africa in 2000.

DESIGN: World Health Organization comparative risk assessment (CRA) methodology was followed. Small community studies were used to derive the prevalence by population group. Population-attributable fractions were calculated and applied to revised burden of disease estimates for the relevant disease categories for each population group. The total attributable burden for South Africa in 2000 was obtained by adding the burden attributed to high cholesterol for the four population groups. Monte Carlo simulation-modelling techniques were used for uncertainty analysis.

SETTING: South Africa.

SUBJECTS: Black African, coloured, white and Indian adults aged 30 years and older.

OUTCOME MEASURES: Mortality and disability-adjusted life years (DALYs) from ischaemic heart disease (IHD) and ischaemic stroke.

RESULTS: Overall, about 59% of IHD and 29% of ischaemic stroke burden in adult males and females (30+ years) were attributable to high cholesterol (>or= 3.8 mmol/l), with marked variation by population group. High cholesterol was estimated to have caused 24,144 deaths (95% uncertainty interval 22,404 - 25,286) or 4.6% (95% uncertainty interval 4.3 - 4.9%) of all deaths in South Africa in 2000. Since most cholesterol-related cardiovascular disease events occurred in middle or old age, the loss of life years comprised a smaller proportion of the total: 222,923 DALYs (95% uncertainty interval 206,712 - 233,460) or 1.4% of all DALYs (95% uncertainty interval 1.3 - 1.4%) in South Africa in 2000.

CONCLUSIONS: High cholesterol is an important cardiovascular risk factor in all population groups in South Africa.