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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 1, January/February 2021
48
AFRICA
the main burden of CVD is from heart failure (HF), ischaemic
heart disease (IHD) and cerebrovascular disease.
9,10
Premature
deaths (age 30–70 years) attributable to NCD, which included
cancer, diabetes or chronic respiratory diseases, in addition to
CVD, was 26% in 2016.
11
The age-standardised total CVD death
rate was 16.1%, while the percentage of disability-adjusted life
years (DALYs) resulting from CVD was 7.0% in 2017.
12
RHD, which has an estimated prevalence of 1.01%, is one
of the main causes of premature CVD-related morbidity and
mortality in the youth. This prevalence is similar to that of
Tanzania and slightly lower than Mozambique’s 1.09%. The
total RHD mortality rate in 2017 was 0.22% of all deaths, which
is almost similar to that of Cameroon (0.2%), but lower than
Namibia and Senegal (0.27 and 0.28%, respectively) and Sudan’s
0.38% (Table 1).
12
Tobacco and alcohol
The WHO age-standardised prevalence of tobacco use in
adult men and women (≥ 15 years) in 2018 was 46.8 and 16%,
respectively (Table 1).
13
Similar prevalence data suggest that
1.68% of 10–14-year-old boys and 0.81% of girls smoked,
13
while
among the adolescents (13–15-year-olds), 24.3% of boys and
19% of girls used one form or another of tobacco (Table 1).
14
The
estimated annual direct healthcare-related cost of tobacco use
was R11.4 billion (about US$0.77 billion) in 2016.
15
In 2004, the
premature CVD mortality rate attributable to tobacco in South
Africa was 18%.
16
Alcohol is a major contributor to the burden of disease in
South Africa. The three-year (2016–18) average recorded alcohol
consumption per capita (≥ 15 years) was 7.3 litres (Table 1).
14
Among risk factors that drive the most death and disability
combined in 2017, alcohol ranked fourth highest, which is a
slight improvement from 2007 when it ranked third.
17
Raised blood pressure and cholesterol
The percentage of men and women with raised blood pressure
(BP) [systolic BP (SBP) ≥ 140 mmHg or diastolic BP (DBP) ≥ 90
mmHg] was 27.4 and 26.1%, respectively in 2015, which increased
with age.
14
In the first South African National Health and
Nutrition Examination Survey (SANHANES), the prevalence
for raised SBP was 5.3% in persons < 25 years old, rising to
50.5% in the 55–64-year-old group, and 63.7% in those over 65
years.
18
The percentage of DALYs lost because of hypertension
was 5.2%, whereas the mortality rate caused by hypertensive
heart disease was 2.0% in 2017 (Table 1).
12
According to Global Health Observatory data, the estimated
age-standardised raised total cholesterol (TC; ≥ 5.0 mmol/l)
level was 35.5% in 2008, while only Tunisia had a higher TC
level at 40.7%.
14
Data from SANHANES, conversely, indicated
a prevalence of elevated TC in men, 15–65 years and older,
of 18.9% that varied widely by province (Limpopo 10.9% and
Western Cape 34.8%). In women, 15–65 years and older, 28.1%
Table 1. Cardiovascular disease indicators for South Africa
Indicators
Male
Female
Total
Year
Status of the national CVD epidemic
Premature CVD mortality (30–70 years old) (% deaths)
–
–
14
2012
Total CVD mortality (% of deaths)
13.9
18.8
16.1 (31.8)* 2017
Total RHD mortality (% of deaths)
0.23
0.21
0.22 (.5)*
2017
DALYs attributable to CVD (%)
6.8
7.2
7.0 (14.7)* 2017
AF and atrial flutter (%)
0.29
0.29
0.29 (.5)*
2017
Prevalence of RHD (%)
0.91
1.1
1.01 (.5)*
2017
Tobacco and alcohol
Prevalence of adult tobacco use (≥ 15 years old) (%)
46.8 (36.1)** 16 (6.8)**
–
2018
Prevalence of youth (13–15-year-olds) tobacco use (%)
24.3 (18.2)** 19.0 (8.3)**
2011
Estimated direct (healthcare-related) cost of tobacco use in the South African population (current US$)
–
–
0.77
2016
Proportion of premature CVD mortality attributable to tobacco (%)
–
–
18.0 (10)*
2004
Recorded alcohol consumption per capita (≥ 15 years old) (litres of pure alcohol) (three-year average)
–
7.3
2016–18
Raised blood pressure and cholesterol
Population with raised BP (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg) (%)
27.4 (24.1)** 26.1 (20.1)**
-
2015
Population with raised TC (≥ 5.0 mmol/l) (%)
#
18.9
28.1
23.5 (38.9)** 2012
DALYs attributable to hypertension (%)
5.1
5.3
5.2 (8.7)*
2017
Mortality caused by hypertensive heart disease (% of deaths)
1.4
2.8
2.0 (1.7)*
2017
Physical activity
Adolescents (< 13– ≥ 19 years old) who are insufficiently active (< 60 minutes of moderate- to vigorous-
intensity PA daily) (%)
37.7
47.5
42.8 (80.7)** 2011
Adults (age-standardised estimate) who are insufficiently active (< 150 minutes of moderate-intensity PA
per week, or < 75 minutes of vigorous-intensity PA per week) (%)
28.5
47.3
38.2 (27.5)** 2016
Overweight and obesity
Adults who are overweight (BMI ≥ 25–< 30 kg/m
2
) (%)
40.5
65.4
53.8 (38.9)** 2016
Prevalence of obesity (BMI ≥ 30 kg/m
2
) (%)
15.4
39.6
28.3 (13.1)** 2016
Diabetes
Defined population with fasting glucose ≥ 126 mg/dl (7.0 mmol/l) or on medication for raised blood glucose
(age-standardised) (%)
9.7 (9)*
12.6 (8)*
11.3
2014
Prevalence of diabetes (20–79 years old) (%)
–
–
12.7 (9.3)
##
2019
CVD, cardiovascular disease; RHD, rheumatic heart disease; DALYs, disability-adjusted life years; AF, atrial fibrillation; SBP, systolic blood pressure; DBP, diastolic
blood pressure; TC, total cholesterol; PA, physical activity; BMI, body mass index.
*IHME global data exchange;
12
**WHO global data;
14
#
SANHANES;
18
##
IDF Diabetes Atlas
.
20