South Africa

South Africa

  • The majority of Indians in South Africa are the descendants of indentured laborers brought to Natal between 1860 and 1911 to develop the country’s sugar belt. The Indian population of South Africa is composed of both Dravidian and Aryan stock, each having distinct cultural and anthropological characteristics.1 The GOPIO Convention recently celebrated the 150th Anniversary of the advent of Indian indentured workers to Natal.
  • In South Africa, CAD (coronary artery disease) is near absent in rural areas, and very uncommon in urban centers, where many Africans are in an advanced stage of epidemiological transition. Yet CAD rates remains very low despite marked increase in the risk factors in South African blacks.2-5
  • CAD reached ‘epidemic’ proportions in South Africans in the 1970s, with whites in the country having the highest rates in the world.3, 6 Asian Indians had higher rates than whites, and strikingly higher rates at very young ages.7
  • Compared to blacks, the CAD mortality rates were 22 times higher among Indian men and 12 times higher among Indian women.8 (see Figure 025 in Diasporas Overview)
  • Between 1970 and 1985, CAD mortality declined in all groups but was slower among Indians (25%) than whites (37%) and blacks (20%).8
  • Heart disease among Indians in South Africa is both premature and severe. In a study of those who suffered a heart attack before age 45, more than half had triple-vessel disease (meaning all three major arteries are blocked indicating very severe heart disease).9 This high prevalence of three-vessel disease in young Indians is consistent with studies conducted on Indians in other parts of the world.10
  • The apoE3/E4 genotype is strongly associated with the incidence of heart attack in young South African Indians. This genotype also adversely affects LDL and HDL cholesterol levels, both of which contribute to premature atherosclerosis, the underlying disease for more than 99% of heart attacks.11
  • Asian Indians have high levels of cholesterol and appears to be an important contributor to premature CAD in this country.1 In one study, approximately 59% of CAD and 29% of ischemic stroke burden in adult males and females (30+ years) were attributable to high cholesterol.12
  • Elevated levels of lipoprotein(a), by far the strongest predictor of prematurity and severity of CAD, has not been studied in South Africa.13


1Seedat YK, Mayet FG, Khan S, Somers SR, Joubert G. Risk factors for coronary heart disease in the Indians of Durban. S Afr Med J. Oct 20 1990;78(8):447-454.

2. Seftel HC. The rarity of coronary heart disease in South African blacks. S Afr Med J. Jul 15 1978;54(3):99-105.

3. Walker AR. Extremes of Coronary Heart Disease Mortality in Ethnic Groups in Johannesburg, South Africa. Am Heart J. Sep 1963;66:293-295.

4. Walker ARP, Adam A, Kustner H. Changes in total death rate and ischemic heart disease death rate in interethnic South African populations, 1978 to 1989. CVD Epidemiological Newsletter. 1994:148 – 149.

5. Walker AR, Walker BF, Segal I. Some puzzling situations in the onset, occurrence and future of coronary heart disease in developed and developing populations, particularly such in sub-Saharan Africa. J R Soc Promot Health. Jan 2004;124(1):40-46.

6. Derry CW, Bourne DE, Sayed AR, et al. Variations in mortality of the coloured, white and Asian population groups in the RSA, 1978-1982. Part VI. Ischaemic heart disease. S Afr Med J. Nov 21 1987;72(10):698-700.

7. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic  USA; 2010.

8. Steinberg WJ, Balfe DL, Kustner HG. Decline in the ischaemic heart disease mortality rates of South Africans, 1968-1985. S Afr Med J. 1988;74(11):547-550.

9. Ranjith N, Verho NK, Verho M, Winkelmann BR. Acute myocardial infarction in a young South African Indian-based population: patient characteristics on admission and gender-specific risk factor prevalence. Current medical research and opinion. 2002;18(4):242-248.

10. Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention, and therapy. Coronary Artery Disease in Asian Indians (CADI) Study. Clinical cardiology. Mar 1995;18(3):131-135.

11. Ranjith N, Pegoraro RJ, Rom L, Rajput MC, Naidoo DP. Lp(a) and apoE polymorphisms in young South African Indians with myocardial infarction. Cardiovasc J S Afr. May-Jun 2004;15(3):111-117.

12. Norman R, Bradshaw D, Steyn K, Gaziano T. Estimating the burden of disease attributable to high cholesterol in South Africa in 2000. S Afr Med J. Aug 2007;97(8 Pt 2):708-715.

13. Enas EA. Lipoprotein(a) is an important genetic risk factor for coronary artery disease in Asian Indians. Am  J  Cardiol. 2001;88:201-202.

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