Prevalence and factors associated with blood lipid profiles among adults in Cabo Verde: a cross-sectional analysis of WHO STEPS 2020

Abstract Background Cardiovascular disease is a leading cause of mortality in Cabo Verde, yet nationally representative evidence on lipid abnormalities and their behavioural correlates remains limited. To estimate the prevalence of raised total cholesterol and low high-density lipoprotein cholesterol (HDL-C), describe their population distribution and examine behavioural associations among adults in Cabo Verde. Methods Secondary analysis of a nationally representative cross-sectional survey. Cabo Verde WHO STEPwise approach to non-communicable disease risk-factor surveillance survey, 2020. Adults aged 18–69 years with valid STEP 3 weights and survey-design information. The analysis included 2436 participants; denominators varied by outcome and model. Raised total cholesterol was defined as total cholesterol ≥ 200 mg/dL or lipid-lowering medication use. Low HDL-C was defined as < 40 mg/dL in men and < 50 mg/dL in women. Survey-weighted prevalence estimates, prevalence ratios (PRs) and mean differences accounted for strata, primary sampling units and weights. Results Mean total cholesterol was 154.6 mg/dL (95% CI 152.2 to 157.0), and 14.4% (12.4% to 16.4%) had raised total cholesterol. Mean HDL-C was 44.1 mg/dL (43.2 to 45.1), and 58.3% (55.0% to 61.5%) had low HDL-C. Raised total cholesterol increased from 3.9% at ages 18–29 years to 34.5% at ages 60–69 years and was more common among adults with obesity. Low physical activity showed an imprecise association with raised total cholesterol (adjusted PR 1.35, 95% CI 0.98 to 1.85). Alcohol use was associated with lower prevalence of low HDL-C (adjusted PR 0.81, 0.70 to 0.93), but higher mean total cholesterol and HDL-C. Conclusions Low HDL-C was widespread, whereas raised total cholesterol showed pronounced age and obesity gradients. Integrated cardiovascular-risk assessment is preferable to interpreting lipid markers in isolation. Unexpected inverse behavioural associations should not be interpreted as protective because temporality could not be established and exposures were self-reported.