N S Levitt

University of Cape Town, Kaapstad, Western Cape, South Africa

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Publications (95)340.43 Total impact

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    ABSTRACT: This study aimed to evaluate the cost-effectiveness of a group diabetes education program delivered by health promoters in community health centers in the Western Cape, South Africa.
    Patient Education and Counseling 01/2015; 94. · 2.60 Impact Factor
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    ABSTRACT: The prevalence of diabetes in South Africa is increasing rapidly, and diabetes is a significant cause of blindness. Diabetic complications can induce a cycle of poverty for affected families. Early detection of retinopathy and appropriate management can prevent blindness. Screening for retinopathy using a mobile retinal camera is highly cost-effective, with costs of screening and follow-up treatment being less than the expense of one year of a disability grant. Such a programme is a prime example of a 'best buy' that should be part of the national diabetes care package.
    10/2014; 104(10):661-2.
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    ABSTRACT: Objectives. To establish the prevalence and determinants of the 10-year risk of a cardiovascular disease (CVD) event in 25 - 74-year-old black Africans in Cape Town, South Africa, using Framingham laboratory- and non-laboratory-based and National Health and Nutrition Examination Survey (NHANES) I non-laboratory-based equations.Methods. CVD risk factors were determined by questionnaires, clinical measurements and biochemical analyses. Survey logistic regression analyses assessed the sociodemographic determinants of CVD risk ≥20%.Results. There were 1 025 participants, 369 men and 656 women. Mean 10-year risk for a CVD event by Framingham laboratory- and non-laboratory-based and NHANES I non-laboratory-based equations for men was 9.0% (95% confidence interval 7.7 - 10.3), 11.1% (9.6 - 12.6) and 9.0% (7.6 - 10.3), and for women 5.4% (4.7 - 6.1), 6.8% (5.9 - 7.7) and 8.7% (7.6 - 9.8). Correlations between laboratory- and non-laboratory-based scores were high (0.915 - 0.963). The prevalence of laboratory-based CVD risk ≥20% was 13.0% in men and 6.1% in women. In the logistic model for men, ≤7 years of education (odds ratio 3.09; 95% CI 1.67 - 5.71) and being unemployed (3.44; 1.21 - 9.81) compared with employed were associated with laboratory-based high risk. In women, high risk was associated with ≤7 years of education (4.20; 1.96 - 9.01), living in formal v. informal housing (2.74; 1.24 - 6.06) and being poor (middle v. lowest tertile 0.29; 0.13 - 0.66). In the Framingham non-laboratory-based logistic models there were no changes in the direction or significance of the variables except for housing, which was no longer significant in women.Conclusions. Comparability of laboratory- and non-laboratory-based CVD risk estimates illustrates the utility of the latter in resource-constrained settings.
    10/2014; 104(10):691-6.
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    ABSTRACT: To ascertain the prevalence and determinants of overweight/obesity in the 25-74-year-old urban black population of Cape Town and examine the changes between 1990 and 2008/09.
    PLoS ONE 09/2014; 9(9):e107471. · 3.53 Impact Factor
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    ABSTRACT: To determine the metabolic syndrome prevalence by the 2009 harmonised criteria in 25-74-year-old urban Africans in Cape Town.
    European Journal of Preventive Cardiology 09/2014; · 2.68 Impact Factor
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    ABSTRACT: Human immunodeficiency virus (HIV) and antiretroviral therapy (ART) are associated with renal disease and increased cardiovascular risk. The relationship between HIV and ambulatory blood pressure (ABP) non-dipping status, a risk factor for cardiovascular events and targetorgan damage, has never been assessed in South Africa. Study objectives were to establish the prevalence of chronic kidney disease, and assess the ABP profile in asymptomatic HIV-positive clinic out-patients.
    Cardiovascular journal of Africa 07/2014; 25(4):153-157. · 0.79 Impact Factor
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    ABSTRACT: Background Black women have lower visceral adipose tissue (VAT) but are less insulin sensitive than white women; the mechanisms responsible are unknown.Objective The study aimed to test the hypothesis that variation in subcutaneous adipose tissue (SAT) sensitivity to glucocorticoids might underlie these differences.Methods Body fatness (dual energy x-ray absorptiometry) and distribution (computerized tomography), insulin sensitivity (SI, intravenous and oral glucose tolerance tests), and expression of 11β-hydroxysteroid dehydrogenase-1 (11HSD1), hexose-6-phosphate dehydrogenase (H6PDH), and glucocorticoid receptor-α (GRα), as well as genes involved in adipogenesis and inflammation were measured in abdominal deep SAT (DSAT), superficial SAT (SSAT), and gluteal SAT (GLUT) depots of 56 normal-weight or obese black and white premenopausal South African (SA) women. We used a combination of univariate and multivariate statistics to evaluate ethnic-specific patterns in adipose gene expression and related body composition and insulin sensitivity measures.ResultsAlthough 11HSD1 activity and mRNA did not differ by ethnicity, GRα mRNA levels were significantly lower in SAT of black compared to white women, particularly in the GLUT depot (0.52±0.21 vs 0.91±0.26 AU, respectively, P<0.01). In black women, lower SAT GRα mRNA levels were associated with increased inflammatory gene transcript levels and abdominal SAT area, and reduced adipogenic gene transcript levels, VAT/SAT ratio and SI. Abdominal SAT 11HSD1 activity associated with increased VAT area and decreased SI in white, but not black women.Conclusions In black SA women, down-regulation of GRα mRNA levels with obesity and reduced insulin sensitivity, possibly via increased SAT inflammation, is associated with reduced VAT accumulation.International Journal of Obesity accepted article preview online, 23 May 2014; doi:10.1038/ijo.2014.94.
    International journal of obesity (2005) 05/2014; · 5.22 Impact Factor
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    ABSTRACT: Hypogonadism may complicate Addison's disease (primary hypoadrenalism), but prevalence and metabolic sequelae of hypogonadism in Addison's disease are poorly described. We recruited patients from the South African Addison's disease national registry who received stable replacement doses of hydrocortisone and had no acute illness. Male biochemical testosterone deficiency was defined as an early morning basal testosterone<9.9 nmol/l and premature ovarian failure (POF) when menopause occurred before 40 years of age. Cardiometabolic risk variables were measured in males only. Male hypogonadism prevalence was 33% (14/42), and 10 patients had newly diagnosed hypogonadism. Two untreated patients had elevated FSH or LH (>10 or 12 IU/l). Testosterone deficiency did not correlate with age, disease duration or hydrocortisone dose. Untreated male hypogonadal subjects had a higher (mean±standard deviation) BMI compared to eugonadal subjects 29.2±4.9 kg/m2 vs. 24.7±3.4 kg/m2 (p=0.01) and a higher median (interquartile range) high-sensitive-CRP 6.4 (2.5-14.0) mg/l vs. 1.45 (0.6-2.8) mg/l (p=0.002). There were no differences between the 2 groups in lipids, lipoproteins and fasting glucose. The median (interquartile range) DHEAS was lower in the hypogonadal 0.31 (0.27-0.37) μmol/l, compared with the eugonadal group 0.75 (0.50-1.51) μmol/l (p=0.005). POF was documented in 11% of female patients. Male testosterone deficiency was highly prevalent in this cohort and was primarily due to secondary hypogonadism. Only BMI and hs-CRP were increased in untreated male hypogonadal subjects. Male and female hypogonadism appears to be a common complication of Addison's disease and may contribute to its morbidity.
    Hormone and Metabolic Research 05/2014; · 2.15 Impact Factor
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    ABSTRACT: Microvascular dysfunction precedes the clinical manifestations of cardiovascular disease (CVD). Given the ethnic disparities in CVD, we aimed to investigate ethnic differences in microvascular endothelial function in a group of young (18–33 yrs), apparently healthy persons (n = 33, 9 Black African, 12 Mixed Ancestry, 12 Caucasian). Microvascular endothelial-dependent and -independent function were assessed by laser Doppler imagery and iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively, adjusting for skin resistance (SR). Microvascular reactivity was expressed as maximum absolute perfusion,% change from baseline, and area under the curve (AUC). SR was significantly lower in the Caucasian group in response to ACh (Caucasian: mean 0.16 ± 0.03 vs. Black: 0.21 ± 0.04 and Mixed Ancestry: 0.20 ± 0.02 ohms, P < 0.01) and SNP (Caucasian: 0.08 ± 0.01 vs. Black: 0.11 ± 0.02 and Mixed Ancestry 0.12 ± 0.01 ohms, P < 0.01). Microvascular function in response to ACh was significantly higher in the Caucasian group, compared to the other two groups, however, after adjusting for SR these differences were no longer significant. Conversely, microvascular SNP response remained significantly higher in the Caucasian group, even after adjusting for SR (P < 0.01). Diastolic blood pressure was inversely associated with the AUC of ACh (r = −0.4) and all SNP responses (r = −0.3 to −0.6). SR was inversely associated with AUC and maximum absolute response ACh (r = −0.59 and −0.64, respectively) and all SNP responses (r = −0.37 to −0.79). Ethnic differences in endothelial-independent microvascular function may contribute to ethnic disparities in CVD. Moreover, SR plays a significant role in the interpretation of microvascular response to iontophoresis outcomes in a multi-ethnic group.This article is protected by copyright. All rights reserved
    Experimental physiology 05/2014; · 2.87 Impact Factor
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    ABSTRACT: To examine the prevalence and determinants of tobacco use in the 25-74-year-old urban Black population of Cape Town and to examine the changes between 1990 and 2008/09 in the 25-64-year-old sample. In 2008/09 (n = 1,099), a representative cross-sectional sample was randomly selected from the same townships sampled in 1990 (n = 986). Sociodemographic characteristics, tobacco use by the World Health Organization (WHO) STEP-wise questionnaire, and psychosocial stress, including sense of coherence (SOC), locus of control, and adverse life events, were determined. Survey logistic regression analysis assessed the determinants of smoking ≥1 cigarette/day. There were 392 men and 707 women. Age-standardized prevalence of smoking ≥1 cigarette/day was 48.5% (95% confidence interval [CI] = 43.0-54.0) in men and 7.8% (95% CI = 5.8-10.5) in women (p < .001). Prevalence in men was lower in 2008/09 (51.0%, 95% CI = 45.2-56.7) compared with 1990 (59.7%, 95% CI = 53.8-65.4) but unchanged in women (2008/09: 8.0%, 95% CI = 5.9-10.7; 1990: 8.4%, 95% CI = 6.0-11.8). In the logistic model for men, smoking was associated with younger age (p = .005) and being poor (p = .024). In women, spending more than half their lives in the city (p < .001), being poor (p = .002), and coping poorly with stress (defined by lower SOC; OR: 1.04, 95% CI = 1.01-1.08; p = .035) were associated with smoking. Increasing number of adverse events, which replaced SOC in the same models, was significant for women (OR: 1.10, 95% CI = 1.01-1.21; p = .047) but not for men. Education level, employment status, and housing quality were not relevant for men or women. The high smoking prevalence in men and unchanged rate in women require additional interventions to curtail this behavior.
    Nicotine & Tobacco Research 04/2014; · 2.48 Impact Factor
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    ABSTRACT: Patients with Addison's disease (AD) in Scandinavia have an increased risk for premature death due to cardiovascular disease (CVD). Serum lipids are important risk factors for CVD and vascular mortality. Replacement doses of hydrocortisone have historically been higher in Sweden than South Africa. The primary aim was to study the lipid profiles in a large group of patients with AD with the hypothesis that the lipid profile in patients in Sweden would be worse than in South Africa. In a cross-sectional study, 110 patients with AD (55 from South Africa, 55 from Sweden) matched for age, gender, ethnicity and BMI were studied. Anthropometric measures, blood pressure, lipids, highly sensitive C-reactive protein (hs-CRP) and adiponectin were studied. All patients were Caucasian and the majority were women N = 36 (65.5%). Mean (standard deviation; SD) ages of the Swedish and South African patients were 52.9 (13.0) and 52.6 (14.4) years and BMI 25.3 (3.2) and 25.8 (4.1) kg/m2, respectively. The mean total daily hydrocortisone dose was greater in the Swedish patients than the South African patients, [33.0 (8.1) versus 24.3 (8.0) mg; p<0.0001]. South African patients had higher median (interquartilerange; IQR) triglycerides (TG) [1.59 (1.1-2.46) versus 0.96 (0.74-1.6) mmol/l; p<0.001], total cholesterol (TC) [6.02(1.50) versus 5.13 (0.87) mmol/l; p<0.001], LDL-C [4.43 (1.44) versus 2.75 (0.80) mmol/l; p<0.001] and median hs-CRP [2.15 (0.93-5.45) versus 0.99 (0.57-2.10) mg/L; p<0.003] and lower HDL-C [0.80 (0.40) versus 1.86 (0.46) mmol/l; p<0.001] than the Swedish patients. Approximately 20% of the patients in both cohorts had hypertension and diabetes mellitus. South African patients with AD have worse lipid profiles and higher hs-CRP compared to their matched Swedish patients, despite lower doses of hydrocortisone. It is uncertain at this time whether these are due to genetic or environmental factors.
    PLoS ONE 03/2014; 9(3):e90768. · 3.53 Impact Factor
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    ABSTRACT: To determine the prevalence and determinants of problematic alcohol use (CAGE ≥2) in 25-74-year-old black population in Cape Town in 2008/2009 and examine the changes in self-reported alcohol consumption between 1990 and 2008/2009 in 25-64-year-olds. In 2008/2009, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Socio-demographic characteristics, the ability to cope with psychosocial stress (sense of coherence) and adverse life events were determined. Ordinal logistic regression analysis assessed the determinants of problem drinking. There were 1099 participants, 392 men and 707 women, in 2008/2009. Prevalence of alcohol consumption in 2008/2009 (men: 68.5%, 95% CI 62.7 to 73.7; women: 27.4%, 95% CI 23.7 to 31.5) was higher than in 1990 (men: 56.7%, women: 15.1%). Prevalence of problem drinking was significantly higher in men (49.7%, 95% CI 44.6 to 54.9) than in women (18.1% 95% CI 15.3 to 21.2) (p<0.001). In men, greater alcohol use was associated with >7 years of education (p=0.012), being unemployed compared with employed (p=0.008) and coping poorly with stress (OR 1.02, 95% CI 1.01 to 1.05, p=0.042), and in women with spending more than half their life in the city (p<0.001) and coping poorly with stress (OR 1.02, 95% CI 1.01 to 1.04, p=0.039). The odds for greater alcohol use with increasing number of adverse life events, after adjusting for the other factors, was significant in men (OR 1.11, 95% CI 1.02 to 1.19, p=0.010) and women (OR 1.09, 95% CI 1.03 to 1.16, p=0.005). Problem drinking is a major problem in this population and requires urgent interventions to curtail the misuse.
    Journal of epidemiology and community health 01/2014; · 3.04 Impact Factor
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    ABSTRACT: Background Primary prevention of cardiovascular disease (CVD),by identifying individuals at risk is a well-established, but costly strategy when based on measurements that depend on laboratory analyses. A non-laboratory, paper-based CVD risk assessment chart tool has previously been developed to make screening more affordable in developing countries. Task shifting to community health workers (CHWs) is being investigated to further scale CVD risk screening. This study aimed to develop a mobile phone CVD risk assessment application and to evaluate it's impact on CHW training and the duration of screening for CVD in the community by CHWs. Methods A feature phone application was developed using the open source online platform, CommCare©. CHWs (n = 24) were trained to use both paper-based and mobile phone CVD risk assessment tools. They were randomly allocated to using one of the risk tools to screen 10-20 community members and then crossed over to screen the same number, using the alternate risk tool. The impact on CHW training time, screening time and margin of error in calculating risk scores was recorded. A focus group discussion evaluated experiences of CHWs using the two tools. Results The training time was 12.3 hrs for the paper-based chart tool and 3 hours for the mobile phone application. 537 people were screened. The mean screening time was 36 minutes (SD = 12.6) using the paper-base chart tool and 21 minutes (SD = 8.71) using the mobile phone application, p = <0.0001. Incorrect calculations (4.3% of average systolic BP measurements, 10.4% of BMI and 3.8% of CVD risk score) were found when using the paper-based chart tool while all the mobile phone calculations were correct. Qualitative findings from the focus group discussion corresponded with the findings of the pilot study. Conclusion The reduction in CHW training time, CVD risk screening time, lack of errors in calculation of a CVD risk score and end user satisfaction when using a mobile phone application, has implications in terms of adoption and sustainability of this primary prevention strategy to identify people with high CVD risk who can be referred for appropriate diagnoses and treatment.
    International Journal of Medical Informatics. 01/2014;
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    ABSTRACT: To determine the prevalence, associations and management of hypertension in the 25-74-year-old urban black population of Cape Town and examine the change between 1990 and 2008/09 in 25-64-year-olds. In 2008/09, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Cardiovascular disease risk factors were determined by administered questionnaires, clinical measurements and fasting biochemical analyses. Logistic regression models evaluated the associations with hypertension. There were 1099 participants, 392 men and 707 women (response rate 86%) in 2008/09. Age-standardised hypertension prevalence was 38.9% (95% confidence interval (CI): 35.6-42.3) with similar rates in men and women. Among 25-64-year-olds, hypertension prevalence was significantly higher in 2008/09 (35.6%, 95% CI: 32.3-39.0) than in 1990 (21.6%, 95% CI: 18.6-24.9). In 2008/09, hypertension odds increased with older age, family history of hypertension, higher body mass index, problematic alcohol intake, physical inactivity and urbanisation. Among hypertensive participants, significantly more women than men were detected (69.5% vs. 32.7%), treated (55.7% vs. 21.9%) and controlled (32.4% vs. 10.4%) in 2008/09. There were minimal changes from 1990 except for improved control in 25-64-year-old women (1990∶14.1% vs. 2008/09∶31.5%). The high and rising hypertension burden in this population, its association with modifiable risk factors and the sub-optimal care provided highlight the urgent need to prioritise hypertension management. Innovative solutions with efficient and cost-effective healthcare delivery as well as population-based strategies are required.
    PLoS ONE 11/2013; 8(11):e78567. · 3.53 Impact Factor
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    ABSTRACT: Six patients from the phase 3 trials of zoledronic acid in Paget's disease, who had received zoledronic acid initially and had subsequently relapsed, were entered into an open re-treatment study. Following re-treatment, each patient reached similar absolute nadirs of serum alkaline phosphatase to those recorded after their first dose. No significant adverse events were reported. It is concluded that, while re-treatment of Paget's disease with zoledronic acid is rarely needed, it is safe and effective, with no evidence of treatment resistance based on this small cohort.
    BoneKEy reports. 11/2013; 2:442.
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    ABSTRACT: Patients with Addison's disease (AD) are believed to be at risk for cardiovascular disease (CVD). South Africa, like the rest of the developing world is experiencing an increase in CVD and patients with AD may be at double the risk of their peers. We wished to explore AD patients' CVD risk factors. A cross-sectional nationwide study in South Africa of patients with AD was conducted. A cohort of 147 patients with AD and 147 healthy control subjects were matched by age, gender, ethnicity, and BMI as far as was possible. Lipoproteins and highly-sensitive C-reactive-protein (hs-CRP) were the main outcome measures. AD patients had significantly higher triglycerides; (p=0.001), lower HDLC (p<0.001), higher hs-CRP (p<0.001), and more small dense LDL; (p=0.002) than controls. Nonesterified fatty acids were lower in patients (p<0.001). Approximately 65% [95% confidence interval (CI 55.6-72.4%)] had hypercholesterolaemia, 75% (CI 64.8-81.2%) had low HDLC, and 75% (CI 68.0-84.1%) had a higher LDLC. Thirteen percent of AD patients had diabetes mellitus, but none of the risk factors differed from the nondiabetics. Only HDLC correlated positively with daily hydrocortisone dose (r=0.32; p=0.005). In conclusion dyslipidaemia is common in South African AD patients; CVD risk assessment and intervention are probably warranted in the management of these patients.
    Hormone and Metabolic Research 08/2013; · 2.15 Impact Factor
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    ABSTRACT: All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as 'high' or 'low' risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as 'high' or 'low' risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as 'high CVD risk' (10-year CVD death risk >20%) using the non-laboratory-based score. We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa.
    BMC Medicine 07/2013; 11(1):170. · 7.28 Impact Factor
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    ABSTRACT: To determine the prevalence, determinants, and management of dyslipidaemia in the 25-74-year-old urban black population of Cape Town and examine the changes between 1990 and 2008/09 in the 25-64-year-old sample. In 2008/09, a representative cross-sectional sample, stratified for age and sex, was randomly selected from the same townships sampled in 1990. Cardiovascular disease (CVD) risk factors were determined by questionnaires, clinical measurements, and fasting biochemical analyses. Survey logistic regression analysis assessed the determinants of raised low-density lipoprotein cholesterol (LDL-C). There were 1099 participants in 2008/09 (392 men and 707 women; response rate 86%). The prevalence of raised total cholesterol (TC), raised LDL-C, and reduced high-density lipoprotein cholesterol (HDL-C) were 25.2% (95% confidence interval, CI, 20.0-31.3), 37.8% (95% CI 32.5-43.4), and 55.2% (95% CI 49.9-60.4) in men and 23.1% (95% CI 20.0-26.5), 47.0% (95% CI 43.1-50.9), and 66.8% (95% CI 62.9-70.5) in women, respectively. Between 1990 and 2008/09, raised LDL-C and reduced HDL-C prevalence increased significantly with no change for raised TC. Among participants with raised LDL-C, only 2.6% were aware of their diagnosis, 2.7% were on treatment, and 1.5% had LDL-C <3 mmol/l. In the logistic model, increasing age (odds ratio, OR, 1.04, 95% CI 1.03-1.05; p < 0.001), rising body mass index (OR 1.03, 95% CI 1.01-1.05; p = 0.003), and fat intake ≥30% of diet (OR 1.37, 95% CI 1.02-1.85; p = 0.035) were significantly associated with LDL-C ≥3 mmol/l but not sex, physical activity, or urbanization. The dyslipidaemia pattern in this population requires full lipogram screening in high-risk individuals and demands improved management using a total CVD risk approach.
    European journal of preventive cardiology. 07/2013;
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    ABSTRACT: South Africa like many other developing countries is experiencing an epidemiologic transition with a marked increase in the non-communicable disease (NCD) burden. Diabetic retinopathy is the most common cause of incidental blindness in adults. A screening programme using a mobile fundal camera in a primary care setting has been shown to be effective in the country. Information on affordability and cost is essential for policymakers to consider its adoption. Economic evaluation is the comparative analysis of competing alternative interventions in terms of costs and consequences. A cost effectiveness analysis was done using actual costs from the primary care screening programme. A total of 14,541 patients were screened in three primary healthcare facilities in the Western Cape. Photographs were taken by a trained technician with supervision by an ophthalmic nurse. The photographs were then read by a medical officer with ophthalmic experience. A cost effective ratio of $1206 per blindness case averted was obtained. This included costs for screening and treating an individual. The cost just to screen a patient for retinopathy was $22. The costs of screening and treating all incident cases of blindness due to diabetes in South Africa would be 168,000,000 ZAR ($19,310,344) per annum. Non mydriatic digital fundoscopy is a cost effective measure in the screening and diagnosis of diabetic retinopathy in a primary care setting in South Africa. The major savings in the long term are a result of avoiding government disability grant for people who suffer loss of vision.
    Diabetes research and clinical practice 06/2013; · 2.74 Impact Factor
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    ABSTRACT: Background: Studies suggest that mitochondrial DNA (mtDNA) haplogroups are associated with antiretroviral therapy (ART)-related metabolic complications and distal sensory polyneuropathy (DSP), but there have been few studies in persons of African descent. We explored such associations in South African adults. Methods: Clinical and laboratory data and DNA specimens from a cross-sectional study were used. Sequencing and Phylotree determined African mtDNA subhaplogroups. Wilcoxon and regression analyses determined associations between mtDNA subhaplogroups and ART-related complications. Results: The 171 participants represented 6 major haplogroups: L0 (n=78), L1 (n=3), L2 (n=30), L3 (n=53), L4 (n=1) and L5 (n=6). Analyses were restricted to 161 participants representing L0, L2 and L3: 78% female; median age 36 years. All had been exposed to thymidine analogues, 42% were on lopinavir/ritonavir (lopinavir/r) and 58% were on either efavirenz or nevirapine. Median (IQR) ART duration was 22 (14-36) months. Median fasting triglycerides were 1.60 (1.13-1.75) and 1.04 (0.83-1.45) mmol/L among L3e1 (n=22) and other subhaplogroups, respectively (p=0.003). Subhaplogroup L3e1 (adjusted OR (aOR) 3.15 [95% CI: 1.11-8.96]; p=0.03) and exposure to lopinavir/r (aOR 2.98 [95% CI: 1.02-8.96]; p=0.05) were independently associated with hypertriglyceridaemia, after adjusting for age, sex and ART duration. There were no significant associations between mtDNA haplogroups and cholesterol, dysglycaemia, hyperlactataemia, or lipoatrophy, or DSP. Conclusions: Subhaplogroup L3e1 and lopinavir/r exposure were independently associated with hypertriglyceridaemia in black South Africans on ART. This is the first report to link an African mtDNA variant with hypertriglyceridemia. If replicated, these findings may provide new insights into host factors affecting metabolic complications.
    AIDS research and human retroviruses 02/2013; · 2.18 Impact Factor

Publication Stats

1k Citations
340.43 Total Impact Points

Institutions

  • 1982–2014
    • University of Cape Town
      • • MRC/UCT Research Unit for Exercise Science & Sports Medicine (ESSM)
      • • Department of Medicine
      Kaapstad, Western Cape, South Africa
  • 2010
    • Walter Sisulu University
      • Department of Internal Medicine
      Umtata, Province of Eastern Cape, South Africa
  • 1994–2010
    • Groote Schuur Hospital
      Kaapstad, Western Cape, South Africa