CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 5, September/October 2010
268
AFRICA
Coping and metabolic syndrome indicators in urban
black South African men: the SABPA study
A DU PLESSIS, L MALAN, NT MALAN
Summary
Urbanisation is associated with obesity, hypertension and
development of the metabolic syndrome (MS). We aimed to
assess the use of different coping styles and their influence
on increases in MS indicators and target end-organ damage
(TOD) in urban black African men. A sample of 53 men
was classified as clear high active (AC,
n
=
30) or passive
coping (PC,
n
=
23) responders, using the Amirkhan African
validated coping style indicator. Blood pressure (BP) was
recorded with an aneroid sphygmomanometer and waist
circumference (WC) was determined. Carotid intima–media
thickness (CIMT) and microalbuminuria were analysed to
determine TOD.
Fasting serum and eight-hour urine samples revealed
elevated MS indicators in AC men. Strong associations
existed between MS indicators and TOD in AC but not PC
men. To conclude, only BP and seeking social support were
positively associated with TOD in urban PC African men,
while in urban AC African men, most MS indicators were
positively associated with TOD, i.e. sub-clinical atherosclero-
sis and renal impairment.
Keywords:
Africans, urban, coping, metabolic syndrome, hyper-
tension, obesity
Submitted 25/11/09, accepted 10/3/10
Cardiovasc J Afr
2010;
21
: 268–273
DOI: CVJ-21.015
The World Heart Federation stated in 2006 that obesity is
associated with type 2 diabetes, hypertension and the meta-
bolic syndrome (MS), all of which cause cardiovascular disease
(CVD).
1
As obesity is on the increase in South Africa, especially
in urban areas, with up to 45% of the population already over-
weight, the prevalence of the MS is increasing.
2
The THUSA
study (Transition and Health during Urbanisation in South
Africa) revealed a greater prevalence of CVD and MS indicators
in urban black South Africans (hereafter referred to as Africans).
3
Furthermore, Malan
et al
.
3-5
revealed that urban African men
utilising an active coping (AC) style were at an increased risk for
hypertension, the MS and increased blood glucose values.
Van Rooyen
et al
. stated that the BP of Africans changes
proportional to their age, level of urbanisation, and waist-to-hip
ratio.
6
There is a high prevalence of hypertension in African-
Americans.
7
This is mostly due to increased sodium retention,
dietary deficiencies and augmented socio-economic stress asso-
ciated with westernisation.
7
Analogous with the aforementioned,
black adults in most industrialised societies have extraordinarily
high hypertension rates, which are probably due to increased salt
sensitivity in this population group.
8
Contrasting literature also exists relating to specific coping
styles and their influence on cardiovascular status. Malan
et al
.
indicated in 2008 that urban Africans utilising an active coping
style were at an increased risk for hypertension and the MS.
3-5
This was opposed to van Rhenen
et al.
who stated that utilising
an AC style promotes health.
9
In accord with van Rhenen, Obrist stated that an AC style
is associated with problem solving, perception of control and
central cardiac
β
-adrenergic response patterns [increases in
systolic (SBP) and diastolic blood pressure (DBP), as well as
cardiac contractility and output].
10
A PC style, on the other hand,
is rather associated with hopelessness and depression, indicating
loss of control and increases in vascular
α
-adrenergic response
patterns [e.g. DBP, peripheral resistance (TPR), with subsequent
decreases in arterial compliance].
10
In 2004, it was rather a PC
style, an avoidant strategy, which correlated positively with blood
pressure levels, which in turn was correlated with pathology.
11,12
According to the International Diabetes Federation (2006),
there are five cardiovascular risk factors underlying the develop-
ment of the metabolic syndrome. These are abdominal obesity,
diabetes, high blood pressure, and high levels of blood glucose
and high-density lipoprotein (HDL).
13
Nevertheless, sedentary
lifestyle, higher dietary fat intake and psychosocial stress are
also major contributing factors in the development of the MS.
14
Atherogenic dyslipidaemia is generally observed in MS
patients.
13-17
A combination of elevated serum triglycerides
and apolipoprotein B, together with reduced HDL levels, and
increased VLDL (very low-density lipoprotein) values is typi-
cally reported.
12
Dyslipidaemia is associated with coronary heart
disease and progression of target end-organ damage, and its
levels increase with lower socio-economic status in developing
countries.
18
In the present study, the main aim was to assess whether a
relationship could be observed between individual risk factors
that may constitute the MS in urban African men, and the utili-
sation of specific coping styles. The hypotheses are then, firstly,
that utilising an AC style will be associated with negative chang-
es in individual indicators of the MS in urban African men, and
secondly, that the changes in MS indicators will be associated
with target end-organ damage, depicted by carotid intima–media
thickness and microalbuminuria.
Methods
The SABPA study (Sympathetic Activity and Ambulatory Blood
Pressure in Africans), a target population study on black South
African teachers, was conducted from February to May 2008. It
included 101 recruited urban black African males aged between
25 and 60 years, with the same socio-economic status, and
School for Physiology, Nutrition and Consumer Sciences,
North-West University, Potchefstroom, South Africa
A DU PLESSIS, BSc
L MALAN, RN, PhD,
NT MALAN, DSc
