The social transition of risk factors for cardiovascular disease in the African region: Evidence from three cross-sectional surveys in the Seychelles ☆ Silvia Stringhini a, 1 , Bharathi Viswanathan b, 1 , Jude Gédéon b, 1 , Fred Paccaud a, 1 , Pascal Bovet a, b, ⁎ , 1 a Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland b Ministry of Health, Victoria, Republic of Seychelles abstract article info Article history: Received 26 July 2012 Received in revised form 1 November 2012 Accepted 11 November 2012 Available online 30 November 2012 Keywords: Social determinants Cardiovascular risk factors Trends Africa Low and middle income countries Survey Objectives: To examine the association between socioeconomic status (SES) and several cardiovascular disease risk factors (CVRFs) and to assess whether this association has changed over a 15-year observation period. Methods: Three independent population-based surveys of CVRFs were conducted in representative samples of all adults aged 25–64 years in the Seychelles, a small island state located east to Kenya, in 1989 (N=1081), 1994 (N=1067) and 2004 (N=1255). Results: Among men, current smoking and heavy drinking were more prevalent in the low versus the high SES group, and obesity was less prevalent. The socioeconomic gradient in diabetes reversed over the study period from lower prevalence in the low versus the high SES group to higher prevalence in the low SES group. Hyper- cholesterolemia was less prevalent in the low versus the high SES group in 1989 but the prevalence was similar in the two groups in 2004. Hypertension showed no consistent socioeconomic pattern. Among women, the SES gradient in smoking tended to reverse over time from lower prevalence in the low SES group to lower preva- lence in the high SES group. Obesity and diabetes were more common in the low versus the high SES group over the study period. Heavy drinking, hypertension and hypercholesterolemia were not socially patterned among women. Conclusion: The prevalence of several CVRFs was higher in low versus high SES groups in a rapidly developing country in the African region, and an increase of the burden of these CVRFs in the most disadvantaged groups of the population was observed over the 15 years study period. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction In low and middle income countries (LMICs), the global burden of cardiovascular disease (CVD) is projected to increase over the next de- cades due to epidemiologic and demographic transitions [1,2]. In partic- ular, it is expected that the population prevalence of several risk factors for cardiovascular diseases (CVRFs), mainly unhealthy behaviours (to- bacco use, lack of physical activity, unhealthy diet) and physiological risk factors (blood pressure, blood lipid levels and diabetes), will rise as a consequence of lifestyle changes associated with globalisation and urbanisation and related nutritional transition [3–5]. Research in high income countries has consistently shown that so- cioeconomic status (SES) is among the strongest determinants of the population distribution of CVRFs and CVD [6]. However, the association between SES and CVRFs has reversed over time from higher prevalence in the higher socioeconomic groups to higher prevalence in the most disadvantaged sections of the population [7,8]. Fewer studies have ex- amined the social distribution of CVRFs in LMICs, but cigarette smoking, obesity and diabetes have generally been found to be directly associated with SES (i.e. higher prevalence in the higher SES groups) [9–12]. How- ever, recent studies suggest that a “social transition” similar to that ob- served in high income countries might be taking place in LMICs [10,13–17]. The general lack of reliable time series data on the socioeco- nomic distribution of CVRFs in LMICs, in particular in the African region, has made it difficult to assess this hypothesis by examining time trends in single countries. In Seychelles, a small island state located east to Kenya, repeated cross-sectional surveys conducted between 1989 and 2004 make it pos- sible to examine changes in the social patterning of CVRFs over time. This study examines the association between SES and several CVRF (current smoking, heavy drinking, obesity, diabetes, hypertension and International Journal of Cardiology 168 (2013) 1201–1206 ☆ Funding: The surveys were funded by the Ministry of Health, Republic of Seychelles (all surveys), the Department of Cooperation, Jura Canton, Switzerland (1989), the Swiss Na- tional Foundation for Science (1994; Prosper 3233-038792), the Hospital Services of Vaud Canton, Switzerland (1994, 2004), the World Health Organization (2004), and the Lausanne University Institute of Social and Preventive Medicine (all surveys). Silvia Stringhini is supported by a post-doctoral fellowship from the Swiss School of Public Health (SSPH+). ⁎ Corresponding author at: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland. Tel.: +41 213147246. E-mail address: Pascal.Bovet@chuv.ch (P. Bovet). 1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 0167-5273/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2012.11.064 Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard