Serum-cholesterol, diet, and coronary heart-disease in Africans and Asians in Uganda*

In the African population of Uganda coronary heart disease is almost non-existent.This statement is confirmed by adequate necropsy evidence 1 .In the Asian community, on the other hand, coronary heart disease is a major problem.During the three years 1956-58 the Kampala health department registered 102 male and 45 female deaths over 30 years of age among Asians and of these 48 (44 male and 4 females) were certified as due to coronary heart disease (''myocardial infarction'', ''coronary thrombosis'').Though the errors inherent in certification must be borne in mind, it is noteworthy that 43% of male deaths and 9% female deaths over 30 years of age were attributed to coronary heart disease.While the significance of a high-serum-cholesterol level in the pathogenesis of coronary atherosclerosis cannot yet be taken as proven, it is supported by much indirect evidence.In a survey of a multiracial community in Cape Town Bronte-Stewart et al. 2 have shown that wide differences in the incidence of coronary heart disease in different races may be associated with a parallel difference in the mean serum-cholesterol levels.Moreover the report of a prospective study 3 , in which blood-lipid measurements were made in healthy men who were then observed for two years, establishes clearly that elevation of blood-lipids precedes clinical coronary disease and that mean serumcholesterol concentrations appear to have a high predictive value for populations; although this cannot be applied to the clinical prediction of coronary heart-disease in the individual.In view of the radically different incidences of coronary heart disease in the two communities in Kampala and their marked differences in social, economic, and dietary backgrounds, we decided to measure serum-cholesterol concentrations in African and Asian males at three age-levels -viz., 12 years, 20 years, and over 40 years.