Tag: hypercholesterolaemia

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High Cholesterol and Insulin Resistance are Rising Among Young South Africans – What that Means for Public Health

On By ModernMedia
Photo by Elizeu Dias on Unsplash

Themba Titus Sigudu, University of the Witwatersrand

In a small mining town in South Africa’s Limpopo province, young people are showing worrying signs of diseases that were once thought to affect only older adults.

These include type 2 diabetes, high blood pressure, high cholesterol, obesity and insulin resistance. This is not unique to Limpopo or South Africa. It reflects a global trend, where young adults in many low- and middle-income countries are increasingly experiencing early-onset metabolic diseases due to rapid urbanisation, lifestyle changes, unhealthy diets and reduced physical activity.

The World Health Organization says non-communicable diseases now account for 75% of all non-pandemic-related deaths globally. Also, 82% of premature deaths before age 70 occur in low- and middle-income countries.

I’m a public health researcher specialising in epidemiology, metabolic health, infectious diseases and environmental health. My colleagues and I conducted a study in the town of Lephalale and found that many young adults there have abnormal cholesterol levels. They also have reduced sensitivity to insulin, a condition known as insulin resistance.

Both are key risk factors for type 2 diabetes and heart disease.

Our findings suggest that these health problems are appearing much earlier in life than expected. This is particularly concerning in communities undergoing rapid social and economic change, where access to health services and screening programmes remains limited.

New jobs, new lifestyles

Lephalale, formerly known as Ellisras, offers a window into these transitions. Once a quiet rural area in the north of South Africa, it has changed rapidly over the past two decades. It is now the site of expanding mining and industrial activities, driven by the expansion of coal mining operations and the development of power stations.

This industrial growth has attracted thousands of workers from surrounding provinces and neighbouring countries, bringing new economic opportunities. It is also reshaping daily life. Increasingly, residents are doing sedentary work and eating energy-dense diets, including fast food. These lifestyle transitions make Lephalale an important setting for studying emerging health risks in young adults.

Long hours sitting at work and reduced physical activity create fertile ground for metabolic disorders. When people eat more processed, high-fat, high-sugar foods and move less, the body begins storing excess energy as fat.

Over time, this can lead to weight gain, elevated blood glucose and abnormal cholesterol levels. These changes make it harder for the body to regulate insulin, causing insulin resistance, the first step towards type 2 diabetes. Also, inactivity and poor diet increase unhealthy cholesterol and triglycerides (types of fat in the blood), raising the risk of heart disease. In rapidly transitioning communities, these health shifts can happen quickly.

Non-communicable diseases such as diabetes, hypertension and heart disease are now among the leading causes of death in South Africa. In 2020, diabetes was reported to be the second biggest underlying cause of death in South Africa, accounting for 6.6% of all deaths.

Our research

We examined 781 young adults aged 18 to 29 years living in Lephalale as part of a long-running study. We have been tracking health patterns in this community since 1992.

Participants provided fasting blood samples that were analysed for glucose, insulin and cholesterol levels. We grouped them into diabetic and non-diabetic categories based on clinical definitions used by the American Diabetes Association.

The results were striking:

  • Diabetic participants had significantly higher total cholesterol, low-density lipoprotein (the “bad” cholesterol) and triglycerides, and lower levels of high-density lipoprotein (the “good” cholesterol) than their non-diabetic peers.
  • Over half (52.7%) of the diabetic group had high total cholesterol, compared with 23% of non-diabetic participants.
  • Insulin resistance, when the body needs more insulin to manage blood sugar, was also much higher among diabetics.
  • Even some non-diabetic participants showed early signs of these metabolic changes.

Unhealthy cholesterol patterns and poor insulin sensitivity tend to occur together, each making the other worse. This combination sets the stage for early heart disease, stroke and diabetes.

Why young adults?

Most public-health strategies focus on older adults because that’s when chronic diseases usually become visible.

But our research adds to growing evidence that the seeds of non-communicable diseases are planted early, often in young adulthood or even adolescence.

Young adults in rural or semi-urban areas may seem healthy, yet many are already developing risks due to diet changes, stress and limited exercise opportunities. The modernisation of small towns, while positive economically, brings hidden health costs.

Without early detection, these individuals may enter middle age already carrying high risk of health problems. This will put pressure on health systems that are already stretched.

What makes this community unique?

Lephalale may be changing, but it still lacks many of the urban services, infrastructure and health resources found in South Africa’s big cities.

Health resources are scarce, and screening for cholesterol or insulin resistance is rare. Public clinics focus on infectious diseases such as HIV or tuberculosis. Silent metabolic disorders go unnoticed until symptoms appear.

Our study shows that rapid industrialisation without parallel investment in public-health education and preventive services risks creating a generation of young adults who are chronically unwell by their thirties.

What can be done?

Three priorities stand out:

Early screening and prevention

Regular cholesterol and glucose testing should be part of routine primary-care visits, especially for adults under 30. Mobile health campaigns, school outreach and workplace screenings could help identify those at risk.

Community-based education

Local awareness campaigns must make the link between diet, physical activity and metabolic health easy to understand. They should show, for example, how frequent consumption of fried or sugary foods contributes to cholesterol build-up and insulin resistance.

Healthy-environment policies

Urban planners and municipalities can support healthy lifestyles by ensuring there are safe spaces for exercise. They must also limit marketing of unhealthy foods, and encourage availability of affordable, nutritious options. Similar “health-in-all-policies” approaches have shown success in other countries. such as Finland’s long-running HiAP strategy, which reduced cardiovascular disease rates and improved population health outcomes.

Young people should be in peak health. Without intervention, today’s young adults risk becoming tomorrow’s chronic-disease patients, burdening families, workplaces and health systems.

Themba Titus Sigudu, Lecturer, University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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High Cholesterol from Childhood Sedentary Time could be Reversed with Light Exercise

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Photo by Victoria Akvarel on Pexels

Increased sedentary time in childhood can raise cholesterol levels by two thirds as an adult, but a new study has found light physical activity may completely reverse the risks and is far more effective than moderate-to-vigorous physical activity.

The study was published in The Journal of Clinical Endocrinology & Metabolism. Researchers used data from the University of Bristol study Children of the 90s (also known as the Avon Longitudinal Study of Parents and Children), which included 792 children aged 11 years who were followed up until the age of 24.

Results from this study found that accumulated sedentary time from childhood can increase cholesterol levels by two thirds (67%) by the time someone reaches their mid-twenties. Elevated cholesterol and dyslipidaemia from childhood and adolescence have been associated with premature death in the mid-forties and heart problems such as subclinical atherosclerosis and cardiac damage in the mid-twenties.

Healthy lifestyles are considered important in the prevention of dyslipidaemia and one of the primary ways of lowering cholesterol, apart from diet, is movement behaviour. For the first time, this study objectively examined the long-term effects of sedentary time, light physical activity, and moderate-to-vigorous physical activity on childhood cholesterol levels.

The World Health Organization currently recommends children and adolescents should accumulate on average 60 minutes of moderate-to-vigorous physical activity a day and reduce sedentary time but have limited guidelines for light physical activity. Yet this new study and other recent studies has found light physical activity – which includes exercises such as long walks, house chores, or slow dancing, swimming, or cycling – is up to five times more effective than moderate-to-vigorous physical activity at promoting healthy hearts and lowering inflammation in the young population.

Dr Andrew Agbaje from the University of Exeter led the study and said: “These findings emphasise the incredible health importance of light physical activity and shows it could be the key to preventing elevated cholesterol and dyslipidaemia from early life. We have evidence that light physical activity is considerably more effective than moderate-to-vigorous physical activity in this regard, and therefore it’s perhaps time the World Health Organization updated their guidelines on childhood exercise — and public health experts, paediatricians, and health policymakers encouraged more participation in light physical activity from childhood.”

During the research, accelerometer measures of sedentary time, light physical activity, and moderate-to-vigorous physical activity were collected at ages 11, 15, and 24 years. High-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, and total cholesterol were repeatedly measured at ages 15, 17, and 24 years. These children also had repeated measurement of dual-energy X-ray absorptiometry assessment of total body fat mass and muscle mass, as well as fasting blood glucose, insulin, and high sensitivity C-reactive protein, with smoking status, socio-economic status, and family history of cardiovascular disease.

During the 13-year follow-up, sedentary time increased from approximately six hours a day to nine hours a day. Light physical activity decreased from six hours a day to three hours a day while moderate-to-vigorous physical activity was relatively stable at around 50 minutes a day from childhood until young adulthood. The average increase in total cholesterol was 0.69 mmol/L. It was observed without any influence from body fat.

An average of four-and-a-half hours a day of light physical activity from childhood through young adulthood causally decreased total cholesterol by (-0.53 mmol/L), however, body fat mass could reduce the effect of light physical activity on total cholesterol by up to 6%. Approximately 50 minutes a day of moderate-to-vigorous physical activity from childhood was also associated with slightly reduced total cholesterol (-0.05 mmol/L), but total body fat mass decreased the effect of moderate-to-vigorous physical activity on total cholesterol by up to 48%. Importantly, the increase in fat mass neutralised the small effect of moderate-to-vigorous physical activity on total cholesterol.

Source: University of Exeter

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Bempedoic Acid Could be a Viable Alternative to Statins

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Photo by Towfiqu Barbhuiya on Unsplash

Bempedoic acid, a new cholesterol-lowering drug, has the potential to be an effective substitute for patients who can’t tolerate statins. Bempedoic acid is an ATP citrate lyase inhibitor that reduces low-density lipoprotein (LDL) cholesterol levels and is associated with a low incidence of muscle-related adverse events. Its effects on cardiovascular outcomes were uncertain, so researchers used a double-blind, randomised, placebo-controlled trial to determine outcomes on a variety of cardiovascular measures in statins-intolerant patients.

The study, published in the New England Journal of Medicine, recruited patients aged 18–85 years at increased cardiovascular risk and unable or unwilling to take statins due to adverse effects. Patients were first tested with placebo over a 4-week run-in period, and were not randomised if they experience unacceptable adverse effects or if adherence was less than 80%. The 13 970 patients who successfully completed run-in were randomised to receive bempedoic acid 180mg orally per day or matching placebo. 

The mean LDL cholesterol level at baseline was 139.0mg/dL in both groups, and after 6 months, the reduction in the level was greater with bempedoic acid than with placebo by 29.2mg/dL; the observed difference in the percent reductions was 21.1 percentage points in favour of bempedoic acid.

Compared to placebo, risk of fatal or nonfatal stroke, death from cardiovascular causes, and death from any cause after significantly were lower by 13%, after a median of 40.6 months of follow-up. The risk of death from cardiovascular causes, nonfatal stroke, or nonfatal myocardial infarction was 15% lower with bempedoic acid than with placebo, and the risks of fatal or nonfatal myocardial infarction and coronary revascularisation were 23% lower and 19% lower, respectively.

The researchers noted that the LDL-cholesterol lowering effects were similar in magnitude and predicted reduction in cardiovascular risks to that observed with statins. In addition, bempedoic acid did not increase glycated haemoglobin levels or the incidence of new-onset diabetes, unlike statins. Due to the demonstrated benefits, those taking placebo were offered the chance to transition to taking bempedoic acid.

A trial limitation was that it only included patients with statins intolerance, and who therefore had higher LDL cholesterol levels at baseline.