Fat intake, serum cholesterol concentration, and atherosclerosis in the South African Bantu. I. Low fat intake and the age trend of serum cholesterol concentration in the South African Bantu.

No vital statistics are available for the Bantu of South Africa, and knowledge of their disease pattern is dependent on clinical impressions and on examination of hospital material, which is, of necessity, selected. The numerous fallacies involved in the interpretation of hospital statistics, especially for heart disease, have recently been reviewed by Mainland (1). Unfortunately, however, such sources at present provide the only adequate information available for the Bantu. There is, however, widespread clinical belief that the more severe complications of atherosclerosis, i.e., coronary and cerebral thrombosis, angina pectoris and intermittent claudication, are rare among Africans. This impression may be due partly to the small number of Africans living to an advanced age. For example, in 1951 only 17 per cent of the patients (excluding children) attending Baragwanath Non-European Hospital were found to be over 45 years of age, in contrast to the figure of 47 per cent for Europeans at the Johannesburg General Hospital. A sample of the population from the native township of Alexandra near Johannesburg in 1953, has shown that rather less than 8 per cent are over 50 years of age (2). That the lower longevity of Africans is not the only reason, however, is suggested by the work of other authors. In Rhodesia, Gelfand (3, 4) has reported that, in his experience, coronary artery disease is very infrequent. Severe atheroma and coronary artery disease have been recorded as uncommon in Uganda (5). In a comprehensive review of post-mortem material among the Bantu in Johannesburg, Becker (6) concluded that coronary thrombosis with infarction was rare.