Coronary heart disease and coronary disease risk factors in black populations in underdeveloped countries: the case for primordial prevention.
Coronary heart disease (CHD) is relatively rare in black populations in Africa and is a much less significant cause of morbidity and mortality in black populations in the Caribbean than in U.S. blacks. The incidence of CHD appears to be increasing in segments of some black populations in underdeveloped countries, concurrently with certain patterns of socioeconomic change. Hypertension, hypercholesterolemia, and cigarette smoking are not as common in most of these black populations as in white populations in industrialized countries, although certain affluent groups in African and Caribbean countries have higher levels of some of these risk factors than do the rest of the population. Moreover, the impact on CHD of these risk factors, especially hypertension, appears to be less than is observed in industrialized countries. The absence of mass hyperlipidemia probably accounts for the lower prevalence and incidence of CHD. A policy of primordial prevention of CHD, by control of risk factors and preemptive action to prevent their establishment in the population, has been recommended to Third World governments by a World Health Organization Expert Committee. The need for such a policy, and its applicability in black populations in Africa and the Caribbean, are limited by their socioeconomic situations. Thus for practical purposes, the deteriorating economic situation in the low-income countries (the majority) of sub-Saharan Africa and the Caribbean restricts the possibilities of adverse risk factor changes. In particular, the widespread assumption of the food consumption patterns typical of industrialized countries and the development of mass hyperlipidemia are effectively prevented. In contrast, attempts to foster or maintain desirable food consumption patterns are warranted in middle-income African and Caribbean countries, especially among newly affluent minorities. In all of these territories, primary prevention of hypertension, especially in urban populations, is the ideal approach to the primordial prevention of cardiovascular diseases, of which CHD is a small component.