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Narendrula A, Brinza E, Horvat Davey C, Longenecker CT, Webel AR. Relationship between objectively measured physical activity and subclinical cardiovascular disease: a systematic review. BMJ Open Sport Exerc Med 2024; 10:e001596. [PMID: 38292295 PMCID: PMC10826575 DOI: 10.1136/bmjsem-2023-001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
Introduction The association of physical activity (PA) with subclinical cardiovascular disease (CVD) is unclear. Clarifying this relationship may inform cardiovascular prevention strategies. Methods We performed a systematic review (CRD42021226089) using Medline, Embase, CINAHL and Cochrane (1 January 2000 to 1 September 2023). Studies published with adult populations exploring the relationship between objectively measured PA and subclinical CVD were included. Subclinical CVD was assessed using: ankle-brachial index (ABI); arterial stiffness; carotid artery disease; coronary artery atherosclerosis; endothelial function; and measures of cardiac structure and function. The Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and Cochrane Risk of Bias tools were used for quality review. Results Of 68 included studies, most supported an inverse relationship between PA and subclinical CVD. Arterial stiffness was the most common outcome (n=40), and 33 studies suggested that less sedentary behaviour (SB), increased PA and/or higher intensity PA was associated with less arterial stiffness. Ten studies of carotid artery disease (total n=18), six of endothelial function (n=10), two of coronary artery disease (n=3) and all of ABI (n=6) suggested that PA or less SB is associated with less subclinical disease. Five studies assessing cardiac structure/function (n=6) suggested alterations in structure/function with PA. Conclusions PA reduces the risk of CVD events, and this systematic review demonstrates that some of the benefits may be mediated by an inverse association between PA and subclinical CVD. Interventions to increase PA are important for CVD prevention, so we provide a comprehensive overview of which surrogate outcome measures may be most useful to assess future CVD prevention interventions. PROSPERO registration number CRD42021226089.
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Affiliation(s)
- Aparna Narendrula
- Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Ellen Brinza
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine Horvat Davey
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Chris T Longenecker
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Allison R Webel
- University of Washington School of Nursing, Seattle, Washington, USA
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Dieden A, Malan L, Mels CM, Lammertyn L, Wentzel A, Nilsson PM, Gudmundsson P, Jujic A, Magnusson M. Exploring biomarkers associated with deteriorating vascular health using a targeted proteomics chip: The SABPA study. Medicine (Baltimore) 2021; 100:e25936. [PMID: 34011069 PMCID: PMC8137024 DOI: 10.1097/md.0000000000025936] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/16/2021] [Indexed: 01/05/2023] Open
Abstract
In this observational study, by the use of a multiplex proteomic platform, we aimed to explore associations between 92 targeted proteins involved in cardiovascular disease and/or inflammation, and phenotypes of deteriorating vascular health, with regards to ethnicity.Proteomic profiling (92 proteins) was carried out in 362 participants from the Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) study of black and white African school teachers (mean age 44.7 ± 9.9 years, 51.9% women, 44.5% Black Africans, 9.9% with known cardiovascular disease). Three proteins with <15% of samples below detectable limits were excluded from analyses. Associations between multiple proteins and prevalence of hypertension as well as vascular health [Carotid intima-media thickness (cIMT) and pulse wave velocity (PWV)] measures were explored using Bonferroni-corrected regression models.Bonferroni-corrected significant associations between 89 proteins and vascular health markers were further adjusted for clinically relevant co-variates. Hypertension was associated with growth differentiation factor 15 (GDF-15) and C-X-C motif chemokine 16 (CXCL16). cIMT was associated with carboxypeptidase A1 (CPA1), C-C motif chemokine 15 (CCL15), chitinase-3-like protein 1 (CHI3L1), scavenger receptor cysteine-rich type 1 protein M130 (CD163) and osteoprotegerin, whereas PWV was associated with GDF15, E-selectin, CPA1, fatty acid-binding protein 4 (FABP4), CXCL16, carboxypeptidase B (CPB1), and tissue-type plasminogen activator. Upon entering ethnicity into the models, the associations between PWV and CPA1, CPB1, GDF-15, FABP4, CXCL16, and between cIMT and CCL-15, remained significant.Using a multiplex proteomic approach, we linked phenotypes of vascular health with several proteins. Novel associations were found between hypertension, PWV or cIMT and proteins linked to inflammatory response, chemotaxis, coagulation or proteolysis. Further, we could reveal whether the associations were ethnicity-dependent or not.
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Affiliation(s)
- Anna Dieden
- Department of Biomedical Science, Malmö University
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Biofilms- Research Centre for Biointerfaces, Malmö University, Sweden
| | | | - Catharina M.C. Mels
- Hypertension in Africa Research Team (HART)
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Leandi Lammertyn
- Hypertension in Africa Research Team (HART)
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | | | | | - Petri Gudmundsson
- Department of Biomedical Science, Malmö University
- Biofilms- Research Centre for Biointerfaces, Malmö University, Sweden
| | - Amra Jujic
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Hypertension in Africa Research Team (HART)
- Department of Cardiology, Skåne University Hospital, Malmö
- Wallenberg Center for Molecular Medicine, Lund University, Sweden
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Distinct inflammatory mediator patterns in young black and white adults: The African-predict study. Cytokine 2019; 126:154894. [PMID: 31670005 DOI: 10.1016/j.cyto.2019.154894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Inflammatory mediators have been implicated in the early stages of cardiovascular disease development, including hypertension. Since global reports reflect a higher hypertension prevalence in black than white populations, we hypothesise the involvement of specific inflammatory mediators. We therefore compared a detailed range of 22 inflammatory mediators between young black and white adults, and determined the relationship with blood pressure. APPROACH AND RESULTS We included 1197 adults (20-30 years; 50% black; 52% female) with detailed ambulatory blood pressures. Blood samples were analysed for 22 inflammatory mediators. For pro-inflammatory mediators, the black adults had higher C-reactive protein, interferon-inducible T-cell alpha chemoattractant, macrophage inflammatory protein 3 alpha (all p ≤ 0.008), but lower interferon-gamma, interleukin (IL)-1β, IL-8, IL-12, IL-17A, and tumour necrosis factor alpha (all p ≤ 0.048). For anti-inflammatory mediators the black group consistently had lower levels (IL-5, IL-10 and IL-13 (all p ≤ 0.012)), resulting in generally higher pro-to-anti-inflammatory ratios in black than white adults (p ≤ 0.001). In mediators with pro- and anti-inflammatory functions, the black group had lower granulocyte-macrophage colony-stimulating factor and IL-6 (both p ≤ 0.010). These patterns were confirmed after adjustment for age, sex and waist circumference, or when stratifying by hypertensive status, sex and socio-economic status. Multi-variable adjusted regression analyses and factor analysis yielded no relationship between inflammatory mediators and blood pressure in this young healthy population. CONCLUSIONS Black and white ethnic groups each consistently presented with unique inflammatory mediator patterns regardless of blood pressure, sex or social class. No association with blood pressure was seen in either of the groups.
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Arnold M, Linden A, Clarke R, Guo Y, Du H, Bian Z, Wan E, Yang M, Wang L, Chen Y, Chen J, Long H, Gu Q, Collins R, Li L, Chen Z, Parish S. Carotid Intima-Media Thickness but Not Carotid Artery Plaque in Healthy Individuals Is Linked to Lean Body Mass. J Am Heart Assoc 2019; 8:e011919. [PMID: 31364443 PMCID: PMC6761650 DOI: 10.1161/jaha.118.011919] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/11/2019] [Indexed: 01/08/2023]
Abstract
Background Lean body mass has been identified as a key determinant of left ventricular mass and wall thickness. However, the importance of lean body mass or other body-size measures as normative determinants of carotid intima-media thickness (cIMT), a widely used early indicator of atherosclerosis, has not been well established. Methods and Results Carotid artery ultrasound measurements of cIMT and carotid artery plaque burden (derived from plaque number and maximum size) and measurements of body size, including height, body mass index, weight, body fat proportion, and lean body mass ([1-body fat proportion]×weight), were recorded in 25 020 participants from 10 regions of China. Analyses were restricted to a healthy younger subset (n=6617) defined as never or long-term ex-regular smokers aged <60 years (mean age, 50) without previous ischemic heart disease, stroke, diabetes mellitus, or hypertension and with plasma non-high-density lipoprotein cholesterol <4 mmol/L. Among these 6617 participants, 86% were women (because most men smoked) and 9% had carotid artery plaque. In both women and men separately, lean body mass was strongly positively associated with cIMT, but was not associated with plaque burden: overall, each 10 kg higher lean body mass was associated with a 0.03 (95% CI, 0.03-0.04) mm higher cIMT (P=5×10-33). Fat mass, height, and other body-size measures were more weakly associated with cIMT. Conclusions The strong association of lean body mass with cIMT, but not with plaque burden, in healthy adults suggests a normative relationship rather than reflecting atherosclerotic pathology. Common mechanisms may underlie the associations of lean body mass with cIMT and with nonatherosclerotic vascular traits.
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Affiliation(s)
- Matthew Arnold
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Andrew Linden
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Yu Guo
- Chinese Academy of Medical SciencesBeijingChina
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
- MRC Population Health Research UnitUniversity of OxfordOxfordUnited Kingdom
| | - Zheng Bian
- Chinese Academy of Medical SciencesBeijingChina
| | - Eric Wan
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Meng Yang
- Division of Ultrasound DiagnosisPeking Union Medical College HospitalBeijingChina
| | - Liang Wang
- Division of Ultrasound DiagnosisPeking Union Medical College HospitalBeijingChina
| | - Yuexin Chen
- Centre of Vascular SurgeryPeking Union Medical College HospitalBeijingChina
| | | | - Huajun Long
- NCDs Prevention and Control DepartmentLiuyang CDCLiuyangChina
| | | | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Liming Li
- Chinese Academy of Medical SciencesBeijingChina
- Department of Epidemiology and BiostatisticsSchool of Public HealthPeking University Health Science CenterBeijingChina
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Sarah Parish
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
- MRC Population Health Research UnitUniversity of OxfordOxfordUnited Kingdom
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Enhörning S, Malan L. Copeptin relates to a fatty liver and measures of obesity in a South African population with mixed ethnicities. Endocrine 2019; 65:304-311. [PMID: 31230225 PMCID: PMC6656785 DOI: 10.1007/s12020-019-01977-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/01/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Elevated copeptin, a vasopressin marker, is linked to metabolic disease, and obese rats with low-vasopressin concentration had a decreased risk of liver steatosis. We here investigated the association between copeptin and nonalcoholic fatty liver disease (NAFLD) and possible differences in copeptin concentration between ethnicities. METHODS In this cross-sectional study of 361 South Africans (n = 172 African black, 189 = Caucasian) with a mean age of 45 years and 45% men, plasma copeptin was measured and associated with NAFLD according to a validated fatty liver index accounting for measures of BMI, waist, triglycerides, and gamma-glutamyltransferase. RESULTS There was no significant difference in copeptin concentrations between ethnicities after age and gender adjustment (p = 0.24). Increasing copeptin tertile levels were significantly associated with obesity, overweight, and abdominal obesity, respectively, after multivariate adjustment for age, gender, ethnicity, and high HOMA-IR (p = 0.02 for all). Individuals in the second and third copeptin tertile had an increased odds (95% CI) of NAFLD of 1.77 (1.04-3.02) and 2.97 (1.74-5.06), respectively, compared to the bottom tertile (p < 0.001). The association between increasing copeptin tertile and NAFLD remained significant after adjustment for age, gender, ethnicity, high HOMA-IR, self-reported current alcohol intake, and statin treatment (p = 0.01). CONCLUSIONS Elevated plasma copeptin is independently associated with NAFLD in a population with mixed ethnicities, pointing at the pharmacologically modifiable vasopressin system as a new mechanism behind NAFLD.
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Affiliation(s)
- Sofia Enhörning
- Department of Clinical Science, Lund University, Skåne University Hospital, SE 214 28, Malmö, Sweden.
- Department of Endocrinology, Skåne University Hospital, SE 221 85, Lund, Sweden.
| | - Léone Malan
- Hypertension in Africa Research Team (HART), Centre of Excellence, North-West University, Private Bag x6001, Potchefstroom, 2520, South Africa
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Swart C, Lammertyn L, Welsh PI, Botha-Le Roux S. Vascular Structure and Inflammation in a South African Population: The SABPA Study. Pulse (Basel) 2019; 7:60-68. [PMID: 32399438 DOI: 10.1159/000500899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/09/2019] [Indexed: 02/03/2023] Open
Abstract
Background and Objective Inflammation plays a role in the early onset of cardiovascular disease. However, longitudinal studies on this topic, especially in South African populations, are scant. We explored whether early changes in vascular structure are associated with changes in inflammation. Methods We investigated 303 South African teachers aged 20-65 years at two intervals, three years apart. Standardised methods were used to determine carotid intima-media thickness (IMT) and cross-sectional wall area (CSWA) as measures of vascular structure, as well as the inflammatory markers soluble urokinase plasminogen activator receptor (suPAR), C-reactive protein (CRP) and interleukin-6 (IL-6) at baseline and follow-up. Results IMT and CSWA were higher, while CRP was lower at follow-up than at baseline. After adjusting for confounding factors, percent change in IMT was inversely associated with percent change in suPAR (β = -0.12, p = 0.036; adjusted R<sup>2</sup> = 0.16) only, and only in the highest tertile of percent change in suPAR (r = -0.31; p = 0.002). Conclusion The early structural changes observed are not related to higher inflammatory levels in this South African population. Future studies are needed to investigate the possible protective effect of suPAR on early changes in vascular structure, especially with the focus on cardiovascular disease prevention.
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Affiliation(s)
- Carla Swart
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Leandi Lammertyn
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Paul I Welsh
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Shani Botha-Le Roux
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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Jansen van Vuren E, Malan L, von Känel R, Lammertyn L, Cockeran M, Malan NT. Longitudinal changes of cardiac troponin and inflammation reflect progressive myocyte stretch and likelihood for hypertension in a Black male cohort: The SABPA study. Hypertens Res 2019; 42:708-716. [PMID: 30626934 DOI: 10.1038/s41440-018-0183-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 11/09/2022]
Abstract
Inflammation was cross-sectionally associated with subclinical wall remodeling and hypertension. Whether longitudinal changes (∆) in inflammation, myocyte injury (troponin T), and stretch (N-terminal-pro-B-type natriuretic peptide) are associated with hypertension and ECG left ventricular hypertrophy (ECG-LVH) is unclear. The first prospective analysis in Africa assessing these associations included a cohort of Black and White teachers (N = 338; aged 20-63 years). Fasting blood samples were obtained to measure tumor necrosis factor-alpha (TNF-α), cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Ambulatory blood pressure, 2-lead ECG and resting 10-lead ECG values were obtained. A higher mean hypertensive status (62%) was evident in Blacks compared to Whites (44%, p < 0.001). Over 3-years, NT-proBNP increased in both ethnic groups. No associations were evident in women or in White men. In Black men, ECG-LVH at follow-up was positively associated with baseline cTnT (Adj R2 0.43; β = 0.48; 95% CI 0.28-0.68, p < 0.001) and baseline SBP (Adj R2 0.43; β = 0.29; 95% CI 0.09-0.49, p = 0.006). In Black men, baseline TNF-α (OR = 1.49, 95% CI 1.05-2.14, p = 0.03) and decreased ΔTNF-α (OR = 2.07, 95% CI 1.26-3.40, p = 0.004) increased the likelihood for cTnT levels ≥ 4.2 ng/L. Here, baseline NT-proBNP (OR = 1.12, 95% CI 1.01-1.23, p = 0.03) and ΔNT-proBNP progression (OR = 1.09, 95% CI 1.00-1.81, p = 0.04) increased the likelihood for 24-h hypertension. In conclusion, chronically increased levels of markers of myocyte injury accompanied by progressive myocardial stretch, reflective of cardiac metabolic overdemand, may ultimately increase hypertension and ischemic heart disease risk in a cohort of Black males.
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Affiliation(s)
- Esmé Jansen van Vuren
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa
| | - Leoné Malan
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa.
| | - Roland von Känel
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa.,University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Zurich, Switzerland
| | - Leandi Lammertyn
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa.,North-West University, MRC Research Unit for Hypertension and Cardiovascular Disease, Potchefstroom, South Africa
| | - Marike Cockeran
- North-West University, Medicine Usage in South Africa (MUSA), Potchefstroom, South Africa
| | - Nicolaas T Malan
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa
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Depression Symptoms Facilitated Fibrinolytic Dysregulation and Future Coronary Artery Disease Risk in a Black Male Cohort: The Sympathetic Activity and Ambulatory Blood Pressure in Africans Study. J Cardiovasc Nurs 2018; 32:401-408. [PMID: 27428354 DOI: 10.1097/jcn.0000000000000358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypercoagulation is associated with coronary artery disease (CAD). Whether depression symptoms dysregulate inflammatory and hemostatic markers in an African cohort is not known; therefore, we assessed the relationship between depressive symptoms and inflammatory and hemostatic markers as potential CAD risk markers in an African sex cohort. MATERIAL AND METHODS We included 181 black African urban-dwelling teachers (88 men, 93 women; aged 25-60 years) from the Sympathetic Activity and Ambulatory Blood Pressure in Africans Study. The Patient Health Questionnaire was used to assess depressive symptoms. Fasting plasma concentrations of C-reactive protein, fibrinogen, D-dimer, plasminogen activator inhibitor-1 (PAI-1) and 24-hour blood pressure measures were obtained. RESULTS Moderately severe depression symptom status was similar in the black sex groups. Both sex groups showed a mean hypertensive state and low-grade inflammation (C-reactive protein > 3 mg/L). Levels of PAI-1 were higher in depressed men, whereas D-dimer levels were lower in depressed women when considering concomitant confounders. In black men only, depressive symptoms were associated with levels of PAI-1 (adj. R = 0.12; β = .22 [95% confidence interval, .0-.44]; P = .04) and D-dimer (adj. R = 0.12; β = .28 [95% confidence interval, .08-.48]; P = .01), independent of confounders. CONCLUSION In black men, depression symptoms accompanied by a mean hypertensive status may up-regulate inflammatory and thrombotic processes. Depression symptoms in black men facilitated hypercoagulation or fibrinolytic dysregulation and potentially increased their CAD risk. Early screening of fibrinolytic markers and for the presence of depressive symptoms is recommended.
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Hamer M, Malan NT, Scheepers K, Meiring M, Malan L, Känel RV. Procoagulant reactivity to laboratory acute mental stress in Africans and Caucasians, and its relation to depressive symptoms: The SABPA Study. Thromb Haemost 2017; 110:977-86. [DOI: 10.1160/th13-05-0383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 07/20/2013] [Indexed: 11/05/2022]
Abstract
SummaryThe risk of cardiovascular disease is dramatically increasing in Africans (black). The prothrombotic stress response contributes to atherothrombotic disease and is modulated by depressive symptoms. We examined coagulation reactivity to acute mental stress and its relation to psychological well-being in Africans relative to Caucasians (white). A total of 102 African and 165 Caucasian school teachers underwent the Stroop Color-Word Conflict test. Circulating levels of von Willebrand factor (VWF) antigen, fibrinogen, and D-dimer were measured before and after the Stroop. Cardiovascular reactivity measures were also obtained. All participants completed the Patient Health Questionnaire-9 and the General Health Questionnaire-28 for the assessment of depressive symptoms and total psychological distress, respectively. After controlling for covariates, resting levels of VWF, fibrinogen, and D-dimer were higher in Africans than in Caucasians (all p-values ≤0.006). Depressive symptoms and psychological distress were not significantly associated with resting coagulation measures. Stress reactivity in VWF (p<0.001) and fibrinogen (p=0.016), but not in D-dimer (p=0.27), were decreased in Africans relative to Caucasians with Africans showing greater reactivity of total peripheral resistance (p=0.017). Depressive symptoms, but not general psychological distress, were associated with greater VWF increase (p=0.029) and greater fibrinogen decrease (p=0.030) in Africans relative to Caucasians. In conclusion, Africans showed greater hypercoagulability at rest but diminished procoagulant reactivity to acute mental stress when compared with Caucasians. Ethnic differences in the vascular adrenergic stress response might partially explain this finding. Depressive symptoms were associated with exaggerated VWF reactivity in Africans relative to Caucasians. The clinical implications of these findings for Africans need further study.
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Breet Y, Huisman HW, Kruger R, van Rooyen JM, Gafane-Matemane LF, Ware LJ, Schutte AE. Pulse pressure amplification and its relationship with age in young, apparently healthy black and white adults: The African-PREDICT study. Int J Cardiol 2017; 249:387-391. [PMID: 28893431 DOI: 10.1016/j.ijcard.2017.08.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/06/2017] [Accepted: 08/30/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pulse pressure amplification (PPA), i.e. the amplification from central arteries to the periphery, is inversely related to arterial stiffness, organ damage and mortality. It is known that arterial stiffness is higher in black than white populations, but it is unclear if this is due to early vascular aging. We therefore investigated whether PPA declines earlier in young normotensive black South Africans, when compared to their white counterparts. METHODS We included 875 black and white men and women from the African-PREDICT study (55% black, 41% men), aged 20-30years, with no prior diagnosis of chronic disease, screened for normotensive clinic blood pressure (BP). We determined supine central PP (cPP), and supine brachial systolic- and diastolic BP, from which brachial PP (bPP) was calculated. PPA was defined as the ratio of the amplitude of the PP between these distal and proximal locations (bPP/cPP). RESULTS We found the mean PPA to be lower in black compared to white participants (1.43 vs. 1.46; P=0.013). In black adults PPA declined earlier with increasing age (P-trend<0.001), with a weak trend in whites (P=0.069) after adjustment for sex, socio-economic status, height, heart rate and mean arterial pressure. In multivariable-adjusted regression, we found an independent inverse association between PPA and age only in the black group (β=-0.18, P=0.002). CONCLUSION PPA declines earlier with age in normotensive black adults younger than 30years, exemplifying early vascular aging which may predispose black individuals to future cardiovascular outcomes.
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Affiliation(s)
- Yolandi Breet
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Hugo W Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Johannes M van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Lebo F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Lisa J Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.; MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa..
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Schutte AE, Botha S, Fourie CMT, Gafane-Matemane LF, Kruger R, Lammertyn L, Malan L, Mels CMC, Schutte R, Smith W, van Rooyen JM, Ware LJ, Huisman HW. Recent advances in understanding hypertension development in sub-Saharan Africa. J Hum Hypertens 2017; 31:491-500. [PMID: 28332510 DOI: 10.1038/jhh.2017.18] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/16/2017] [Accepted: 02/03/2017] [Indexed: 12/13/2022]
Abstract
Consistent reports indicate that hypertension is a particularly common finding in black populations. Hypertension occurs at younger ages and is often more severe in terms of blood pressure levels and organ damage than in whites, resulting in a higher incidence of cardiovascular disease and mortality. This review provides an outline of recent advances in the pathophysiological understanding of blood pressure elevation and the consequences thereof in black populations in Africa. This is set against the backdrop of populations undergoing demanding and rapid demographic transition, where infection with the human immunodeficiency virus predominates, and where under and over-nutrition coexist. Collectively, recent findings from Africa illustrate an increased lifetime risk to hypertension from foetal life onwards. From young ages black populations display early endothelial dysfunction, increased vascular tone and reactivity, microvascular structural adaptions as well as increased aortic stiffness resulting in elevated central and brachial blood pressures during the day and night, when compared to whites. Together with knowledge on the contributions of sympathetic activation and abnormal renal sodium handling, these pathophysiological adaptations result in subclinical and clinical organ damage at younger ages. This overall enhanced understanding on the determinants of blood pressure elevation in blacks encourages (a) novel approaches to assess and manage hypertension in Africa better, (b) further scientific discovery to develop more effective prevention and treatment strategies and
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Affiliation(s)
- A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - S Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M T Fourie
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Lammertyn
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M C Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,Department of Medicine and Healthcare Science, Anglia Ruskin University, Chelmsford, UK
| | - W Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - J M van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L J Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - H W Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,South African Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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Schutte CE, Malan L, Scheepers JD, Oosthuizen W, Cockeran M, Malan NT. Cortisol:brain-derived neurotrophic factor ratio associated with silent ischaemia in a black male cohort: the SA BPA study. Cardiovasc J Afr 2017; 27:387-391. [PMID: 27966001 PMCID: PMC5408496 DOI: 10.5830/cvja-2016-065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/29/2016] [Indexed: 11/24/2022] Open
Abstract
Aim Emotional distress has been associated with cardiovascular disease (CVD) in Africans. Cortisol and brain-derived neurotrophic factor (BDNF), as markers of emotional distress, increase cardiometabolic risk. We therefore aimed to investigate associations between cardiometabolic risk markers and the cortisol-to-BDNF ratio (cortisol:BDNF). Methods A cross-sectional study included a bi-ethnic gender cohort (n = 406) aged 44.7 ± 9.52 years. Ambulatory blood pressure (ABPM), ECG, fasting serum cortisol and BDNF levels and cardiometabolic risk markers were obtained. Results Africans had increased incidence of hyperglycaemia and 24-hour silent ischaemic events, and elevated 24-hour blood pressure (BP) and cortisol:BDNF ratios compared to Caucasians. Forward stepwise linear regression analysis underscored a similar trend with associations between hyperglycaemia, 24-hour BP [Adj R2 0.21–0.29; β 0.23 (0.1–0.4); p = 0.01], silent ischaemia [Adj R2 0.22; β 0.40 (0.2–0.6); p < 0.01] and cortisol:BDNF levels in Africans, mostly in the men. Conclusion Attenuated cortisol levels in this group may be indicative of emotional distress and if chronic, drive the cortisol:BDNF ratio to desensitise BDNF. Desensitised cortisol:BDNF may sustain cardiometabolic risk and induce neurodegeneration in African men via silent ischaemia. Compensatory increases in blood pressure to increase perfusion and maintain homeostasis may increase coronary artery disease risk.
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Affiliation(s)
- Christiaan E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa
| | - Leoné Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa.
| | - Jacobus D Scheepers
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa
| | - Woudri Oosthuizen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa
| | - Marike Cockeran
- Statistical Consultation Services, North-West University, Potchefstroom Campus, South Africa
| | - Nicolaas T Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa
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Oosthuizen W, Malan L, Scheepers JD, Cockeran M, Malan NT. The defense response and alcohol intake: A coronary artery disease risk? The SABPA Study. Clin Exp Hypertens 2016; 38:526-32. [PMID: 27399032 DOI: 10.3109/10641963.2016.1163372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Woudri Oosthuizen
- Hypertension in Africa Research Team (HART), School of Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
| | - Leoné Malan
- Hypertension in Africa Research Team (HART), School of Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
| | - Jacobus D. Scheepers
- Hypertension in Africa Research Team (HART), School of Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
| | - Marike Cockeran
- Medicine Usage in South Africa (MUSA), North-West University, Potchefstroom, South Africa
| | - Nicolaas T. Malan
- Hypertension in Africa Research Team (HART), School of Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
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Jansen van Vuren E, Malan L, Cockeran M, Scheepers JD, Oosthuizen W, Malan NT. Fibrosis and coronary perfusion - a cardiovascular disease risk in an African male cohort: The SABPA study. Clin Exp Hypertens 2016; 38:482-8. [PMID: 27380493 DOI: 10.3109/10641963.2016.1151524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Low-grade inflammation has been correlated with risk factors of cardiovascular diseases (CVD). Whether the pro-inflammatory and thrombotic ratio (fibrosis) may contribute to CVD is not known. We therefore aimed to assess whether Cornell Product left ventricular hypertrophy (LVH) is associated with fibrosis and coronary perfusion (silent ischemia) in a bi-ethnic male cohort from South Africa. A cross sectional study was conducted including 165 African and Caucasian men between the ages of 20-65. Fasting blood samples were obtained to measure fibrinogen, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF-α). Ambulatory blood pressure, ECG and 12 lead ECG measures were obtained to determine silent ischemic events (ST events) and LVH, respectively. Africans revealed more silent ischemia, higher 24 h blood pressure, inflammatory, coagulation as well as fibrosis levels than Caucasians. In a low-grade inflammatory state (CRP > 3 mg/l), Africans revealed higher fibrosis (p ≤ 0.01) values, but lower IL-6 and TNF-α values than Caucasians. Linear regression analyses in several models demonstrated positive associations between silent ischemia and fibrosis [Adj. R(2) 0.23; ß 0.35 (95% CI 0.13, 0.58), p ≤ 0.01]. In a low-grade inflammatory state (CRP>3mg/l), fibrinogen predicted AV-block in African men [OR 3.38 (95% CI 2.24, 4.53); p = 0.04]. Low-grade inflammation may induce AV-block through mechanisms involving fibrosis and ischemia to increase the burden on the heart in African men.
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Affiliation(s)
- Esmé Jansen van Vuren
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom Campus, South Africa
| | - Leoné Malan
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom Campus, South Africa
| | - Marike Cockeran
- b Medicine Usage in South Africa (MUSA) , North-West University , Potchefstroom Campus, South Africa
| | - Jacobus D Scheepers
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom Campus, South Africa
| | - Woudri Oosthuizen
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom Campus, South Africa
| | - Nicolaas T Malan
- a Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom Campus, South Africa
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Hyperpulsatile pressure, systemic inflammation and cardiac stress are associated with cardiac wall remodeling in an African male cohort: the SABPA study. Hypertens Res 2016; 39:648-53. [PMID: 27169396 DOI: 10.1038/hr.2016.45] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 12/19/2022]
Abstract
Inflammation may contribute to an increase in cardiac wall stress through pathways related to cardiac remodeling. Cardiac remodeling is characterized by myocyte hypertrophy, myocyte death and modifications of the extracellular matrix. We sought to explore associations among cardiac remodeling, inflammation and myocardial cell injury in a bi-ethnic cohort of South African men and women. We included 165 men (76 African and 89 Caucasian) and 174 women (80 African and 94 Caucasian) between 20 and 65 years of age. Inflammatory markers used were C-reactive protein (CRP), interleukin-6 and tumor necrosis factor-alpha (TNF-α), whereas troponin T (Trop T) and the N-terminal of pro B-type natriuretic peptide (NT-proBNP) were used as cardiac markers. The frequency of ischemic events (ST segment depression) and left ventricular strain (left ventricular hypertrophy: LVH) were monitored by a 24-h recording of ambulatory blood pressure (BP), ECG and 12-lead standard ECG. Hypertension diagnosed with ambulatory monitoring was more frequent in Africans (53.85 vs. 24.59%; P<0.001), as was the number of ischemic events (6±15 (1; 5) vs. 3±6 (0; 3)). Inflammatory markers (CRP, IL-6 and TNF-α) and the degree of LVH were all significantly higher in Africans (P<0.05). BP was associated (P<0.05) with Trop T in men across ethnic groups. In African men, cardiac stress (NT-proBNP) was associated with TNF-alpha (P<0.001), Trop T (P<0.001) and pulse pressure (P=0.048; adjusted R(2)=0.45). The susceptibility for cardiac wall remodeling appears to increase with hyperpulsatile pressure, low-grade systemic inflammation and ventricular stress, and may lead to the development of future cardiovascular events in African men.
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Malan L, Malan NT. Emotional Stress as a Risk for Hypertension in Sub-Saharan Africans: Are We Ignoring the Odds? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:497-510. [PMID: 27421968 DOI: 10.1007/5584_2016_37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Globally most interventions focus on improving lifestyle habits and treatment regimens to combat hypertension as a non-communicable disease (NCD). However, despite these interventions and improved medical treatments, blood pressure (BP) values are still on the rise and poorly controlled in sub-Saharan Africa (SSA). Other factors contributing to hypertension prevalence, such as chronic emotional stress, might provide some insight for future health policy approaches.Currently, Hypertension Society guidelines do not mention emotional stress as a probable cause for hypertension. Recently the 2014 World Global Health reports, suggested that African governments should consider using World Health Organization hypertension data as a proxy indicator for social well-being. However, the possibility that a stressful life and taxing environmental factors might disturb central neural control of BP regulation has largely been ignored in SSA.Linking emotional stress to vascular dysregulation is therefore one way to investigate increased cardiometabolic challenges, neurotransmitter depletion and disturbed hemodynamics. Disruption of stress response pathways and subsequent changes in lifestyle habits as ways of coping with a stressful life, and as probable cause for hypertension prevalence in SSA, may be included in future preventive measures. We will provide an overview on emotional stress and central neural control of BP and will include also implications thereof for clinical practice in SSA cohorts.
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Affiliation(s)
- Leoné Malan
- Hypertension in Africa Research Team (HART), North-West University, Hoffman street, Private Bag X6001, Potchefstroom, 2520, South Africa.
| | - Nico T Malan
- Hypertension in Africa Research Team (HART), North-West University, Hoffman street, Private Bag X6001, Potchefstroom, 2520, South Africa
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Mokwatsi GG, Schutte AE, Kruger R. A biomarker of tissue damage, lactate dehydrogenase, is associated with fibulin-1 and oxidative stress in blacks: the SAfrEIC study. Biomarkers 2015; 21:48-55. [DOI: 10.3109/1354750x.2015.1118532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Defensive coping and renovascular disease risk - Adrenal fatigue in a cohort of Africans and Caucasians: The SABPA study. Physiol Behav 2015; 147:213-9. [PMID: 25911265 DOI: 10.1016/j.physbeh.2015.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/16/2015] [Accepted: 04/18/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Defensive coping is an established cardiovascular risk factor in Africans. Additionally, chronic, excessive or inadequate hypothalamic-pituitary-adrenal axis (HPAA) stress responses could either increase or decrease cortisol responses, which may relate to renal impairment. We scrutinised the relationship between urinary cortisol levels and renovascular disease risk in Africans and Caucasians utilising defensive coping. METHODS Africans (n=168) and Caucasians (n=207) from the SABPA (Sympathetic activity and Ambulatory Blood Pressure in Africans) study were included in our analyses, excluding HIV positive, diabetic, renal impairment, and cortisone users. The Coping Strategy Indicator questionnaire assessed preferred coping responses. Ambulatory blood pressure was recorded together with 8h fasting blood and urine sampling. Renovascular disease risk markers included the albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). RESULTS The main findings revealed that Caucasians with high cortisol showed augmented renovascular disease risk. Conversely, Africans revealed low cortisol levels whilst 21.84% reported experience of severe stress, possibly depicting HPAA hypoactivity. Additionally, these Africans with low cortisol revealed increased ACR and decreased eGFR, which was further enhanced by defensive coping. CONCLUSIONS Defensive coping enhanced renovascular risk in Africans, especially in those with lower cortisol, which may be due to HPAA dysfunction and/or adrenal fatigue.
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Use of metabolomics to elucidate the metabolic perturbation associated with hypertension in a black South African male cohort: the SABPA study. ACTA ACUST UNITED AC 2015; 9:104-14. [DOI: 10.1016/j.jash.2014.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/26/2014] [Accepted: 11/30/2014] [Indexed: 01/06/2023]
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Self-reported alcohol intake is a better estimate of 5-year change in blood pressure than biochemical markers in low resource settings: the PURE study. J Hypertens 2014; 32:749-55. [PMID: 24384847 DOI: 10.1097/hjh.0000000000000093] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite criticism of self-reported alcohol intake, it is a valuable tool to screen for alcohol abuse as a risk factor for cardiovascular disease. We aimed to compare various self-reported estimates of alcohol use with γ-glutamyltransferase (GGT) and percentage carbohydrate deficient transferrin (%CDT) considering their relationship with blood pressure changes (%BP) over a 5-year period in black South Africans. METHOD We recruited 1994 participants and collected 5-year followed up data (N = 1246). Participants completed questionnaires on alcohol intake indicating their former and current alcohol use ('yes' response and 'no' if alcohol was never used). We assessed alcohol intake (in g) using a quantified food frequency questionnaire. We collected blood samples and measured GGT and %CDT. Brachial BP (bBP) was measured at baseline and follow-up and central BP (cBP) at follow-up only. RESULTS Self-reported alcohol intake was significantly associated with the 5-year change in bBP before and after adjusting for confounders (%bSBP: R(2) = 0.263, β = 0.06, P = 0.023; %bDBP: R(2) = 0.326, β = 0.08 P = 0.005), as well as cSBP (R (2)= 0.286, β = 0.09, P = 0.010) and central pulse pressure (R(2) = 0.254, β = 0.06, P = 0.020). GGT and %CDT correlated well with self-reported alcohol intake (r = 0.44; P = 0.001; r = 0.34 P = 0.001), but did not associate significantly with %bBP or cBP at follow-up. CONCLUSION Self-reported alcohol use was strongly associated with a 5-year increase in BP in Africans with a low socio-economic status. This was not found for biochemical measures, GGT and %CDT. Self-reported alcohol intake could be an important measure to implement in primary healthcare settings in middle to low income countries, where honest reporting is expected.
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Hamer M, von Känel R, Reimann M, Malan NT, Schutte AE, Huisman HW, Malan L. Progression of cardiovascular risk factors in black Africans: 3 year follow up of the SABPA cohort study. Atherosclerosis 2014; 238:52-4. [PMID: 25437890 PMCID: PMC4726657 DOI: 10.1016/j.atherosclerosis.2014.11.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 10/31/2014] [Accepted: 11/14/2014] [Indexed: 11/27/2022]
Abstract
Recent work identified a high prevalence of modifiable risk factors for cardiovascular disease (CVD) among urban black South Africans. The aim was to track the progression of CVD risk factors in a multi-ethnic sample of South Africans. Participants were 173 black (aged 47.5 ± 7.8 yrs) and 186 white teachers (aged 49.6 ± 9.9 yrs) that were examined at baseline and 3 years follow-up. Blacks demonstrated a substantially higher prevalence of composite CVD burden (defined as history of physician diagnosed heart disease, use of anti-hypertensives, anti-diabetic, or statin medications at either time point) compared to whites (49.1 vs. 32.0%, p = 0.012) respectively. After controlling for baseline, the black participants demonstrated greater increases in 24 h systolic and diastolic blood pressure, total cholesterol, fasting glucose, fibrinogen, D-dimer, and waist circumference in comparison with whites. In summary, an adverse progression of CVD risk factors was observed in the whole sample, although to a larger degree in black participants. Aggressive treatment strategies for controlling risk factors in black Africans are needed to reduce the increasing burden of CVD in South Africa.
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Affiliation(s)
- Mark Hamer
- Department of Epidemiology and Public Health, University College London, London, UK; Hypertension in Africa Research Team, School for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa.
| | - Roland von Känel
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Manja Reimann
- Autonomic and Neuroendocrinological Laboratory Dresden, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Nico T Malan
- Hypertension in Africa Research Team, School for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
| | - Alta E Schutte
- Hypertension in Africa Research Team, School for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
| | - Hugo W Huisman
- Hypertension in Africa Research Team, School for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
| | - Leone Malan
- Hypertension in Africa Research Team, School for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
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Malan L, Hamer M, Frasure-Smith N, Steyn HS, Malan NT. Cohort Profile: Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) prospective cohort study. Int J Epidemiol 2014; 44:1814-22. [PMID: 25344943 PMCID: PMC4689997 DOI: 10.1093/ije/dyu199] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 01/20/2023] Open
Abstract
Adapting to an over-demanding stressful urban environment may exhaust the psychophysiological resources to cope with these demands, and lead to sympathetic nervous system dysfunction. The evidence that an urban-dwelling lifestyle may be detrimental to the cardiometabolic health of Africans motivated the design of the Sympathetic activity and Ambulatory Blood Pressure in African Prospective cohort study. We aimed to determine neural mechanistic pathways involved in emotional distress and vascular remodelling. The baseline sample included 409 teachers representing a bi-ethnic sex cohort from South Africa. The study was conducted in 2008–09 and repeated after 3-year follow-up in 2011–12, with an 87.8% successful follow-up rate. Seasonal changes were avoided and extensive clinical assessments were performed in a well-controlled setting. Data collection included sociodemographics, lifestyle habits, psychosocial battery and genetic analysis, mental stress responses mimicking daily life stress (blood pressure and haemostatic, cardiometabolic, endothelial and stress hormones). Target organ damage was assessed in the brain, heart, kidney, blood vessels and retina. A unique highly phenotyped cohort is presented that can address the role of a hyperactive sympathetic nervous system and neural response pathways contributing to the burden of cardiometabolic diseases in Africans.
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Affiliation(s)
- Leoné Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa,
| | - Mark Hamer
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa, Department of Epidemiology and Public Health, University College London, London, UK
| | - Nancy Frasure-Smith
- Department of Psychiatry and School of Nursing, McGill University, Montreal, QC, Canada, Centre Hospitalier de l'Université de Montréal and Montreal Heart Institute Research Center, Montreal, QC, Canada and
| | - Hendrik S Steyn
- Statistical Consultation Services, North-West University, Potchefstroom Campus, South Africa
| | - Nicolaas T Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa
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Botha S, Fourie CMT, Schutte R, Kruger A, Schutte AE. Associations of suPAR with lifestyle and cardiometabolic risk factors. Eur J Clin Invest 2014; 44:619-26. [PMID: 24810168 DOI: 10.1111/eci.12278] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 04/30/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Soluble urokinase plasminogen activator receptor (suPAR), a novel indicator of low-grade inflammation, is associated with cardiovascular disease and mortality in the general population, while an unhealthy lifestyle influences inflammatory status. We aimed to explore the relationship of suPAR with lifestyle and cardiometabolic risk factors in a black South African population. DESIGN This cross-sectional study includes 1068 men and women (56·4 ± 10·1 years) from the North West province who took part in the South African leg of the Prospective Urban and Rural Epidemiology (PURE) study in 2010. Captured data included a detailed lifestyle profile (tobacco use, alcohol consumption, physical activity, psychological and dietary intake status), biochemical analyses (suPAR, C-reactive protein (CRP), glucose and lipids), as well as cardiovascular and anthropometric measurements. RESULTS In exploratory analyses, we observed positive relationships between suPAR and lifestyle factors, such as tobacco use (P-trend < 0·001), both alcohol consumption (P-trend = 0·001) and γ-glutamyl transferase (GGT) (P-trend < 0·001) and unemployment (P-trend = 0·002). suPAR and CRP correlated significantly (r = 0·23; P < 0·001). These relationships were confirmed in multiple regression analyses as suPAR independently associated with tobacco use (β = 0·13; P < 0·001), GGT (β = 0·24; P < 0·001) and unemployment (β = 0·07; P = 0·039). suPAR did not associate with the cardiometabolic factors glucose, lipids, blood pressure or measures of adiposity. CONCLUSION suPAR was independently associated with unhealthy lifestyle behaviours, but not with cardiometabolic risk factors suggesting that suPAR, as known predictor of cardiovascular disease and mortality, is augmented by modifiable cardiovascular risk factors. These findings emphasise the need for a healthy lifestyle to decrease the burden of cardiovascular disease in Africans.
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Affiliation(s)
- Shani Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
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Smith AJ, Malan L, Uys AS, Malan NT, Harvey BH, Ziemssen T. Attenuated brain-derived neurotrophic factor and hypertrophic remodelling: the SABPA study. J Hum Hypertens 2014; 29:33-9. [PMID: 24898921 DOI: 10.1038/jhh.2014.39] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/25/2014] [Accepted: 04/02/2014] [Indexed: 11/09/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) has been linked to neurological pathologies, but its role in cardiometabolic disturbances is limited. We aimed to assess the association between serum BDNF levels and structural endothelial dysfunction (ED) as determined by cross-sectional wall area (CSWA) and albumin/creatinine ratio (ACR) in black Africans. Ambulatory blood pressure (BP) and ultrasound CSWA values were obtained from 82 males and 90 females. Fasting blood and 8 h overnight urine samples were collected to determine serum BDNF and cardiometabolic risk markers, that is, glycated haemoglobin (HbA1c), lipids, inflammation and ACR. BDNF median split × gender interaction effects for structural ED justified stratification of BDNF into low and high (⩽/>1.37 ng ml(-1)) gender groups. BDNF values (0.86-1.98 ng ml(-1)) were substantially lower than reference ranges (6.97-42.6 ng ml(-1)) in the African gender cohort, independent of age and body mass index. No relationship was revealed between BDNF and renal function and was opposed by an inverse relationship between BDNF and CSWA (r=-0.17; P=0.03) in the African cohort. Linear regression analyses revealed a positive relationship between systolic BP and structural remodelling in the total cohort and low-BDNF gender groups. In the high-BDNF females, HbA1C was associated with structural remodelling. Attenuated or possible downregulated BDNF levels were associated with hypertrophic remodelling, and may be a compensatory mechanism for the higher BP in Africans. In addition, metabolic risk and hypertrophic remodelling in women with high BDNF underpin different underlying mechanisms for impaired neurotrophin homeostasis in men and women.
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Affiliation(s)
- A J Smith
- Hypertension in Africa Research Team (HART), School for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
| | - L Malan
- Hypertension in Africa Research Team (HART), School for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
| | - A S Uys
- Hypertension in Africa Research Team (HART), School for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
| | - N T Malan
- Hypertension in Africa Research Team (HART), School for Physiology, Nutrition and Consumer Sciences, North-West University, Potchefstroom, South Africa
| | - B H Harvey
- Center of Excellence for Pharmaceutical Sciences, Division of Pharmacology, School for Pharmacy, North-West University, Potchefstroom, South Africa
| | - T Ziemssen
- Department of Neurology, Medical Faculty Carl Gustav Carus, Technische Universität, Dresden, Germany
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Compromised bioavailable IGF-1 of black men relates favourably to ambulatory blood pressure: The SABPA study. Atherosclerosis 2014; 233:139-44. [DOI: 10.1016/j.atherosclerosis.2013.12.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/26/2013] [Accepted: 12/09/2013] [Indexed: 02/01/2023]
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Schutte AE, Volpe M, Tocci G, Conti E. Revisiting the relationship between blood pressure and insulin-like growth factor-1. Hypertension 2014; 63:1070-7. [PMID: 24566078 DOI: 10.1161/hypertensionaha.113.03057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Conflicting evidence exists on the relationship between blood pressure (BP) and insulin-like growth factor-1 (IGF-1). We reviewed available articles and pooled extrapolated regression coefficients for the association between BP and total IGF-1 as reported in the literature and included additional data from 912 individuals from the general population. We identified 20 studies including 11 704 subjects. We also measured total IGF-1, insulin-like binding protein-3, and BP in 912 black and white men and women from South Africa (aged 20-70 years). When plotting positive and negative weighed regression coefficients (29 data points) against IGF-1, we found a significant positive relationship (r=0.31; P<0.001; n=11 704) intercepting the 0 point at 191 ng/mL IGF-1, suggesting an inverse BP/IGF-1 relationship in low IGF-1 conditions, and a positive relationship in overtly high IGF-1 conditions. In conclusion, our findings suggest that the relationship between BP and IGF-1 is dependent on, or related to, IGF-1 concentrations, as an expression of direct or reverse causality. Low IGF-1 bioavailability (associated with aging and vascular deterioration), resistance to IGF-1, and the complex interplay between IGF-1 and other vasoactive hormones could mask the vasoprotective functions of IGF-1 in cross-sectional studies or could modify their functions in prospective studies.
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Affiliation(s)
- Aletta Elisabeth Schutte
- Hypertension in Africa Research Team, North-West University, Hoffman St, Private Bag X6001, Potchefstroom 2520, South Africa.
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Effects of acute and chronic stress on the L-arginine nitric oxide pathway in black and white South Africans: the sympathetic activity and ambulatory blood pressure in Africans study. Psychosom Med 2013; 75:751-8. [PMID: 23960161 DOI: 10.1097/psy.0b013e3182a3e465] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study investigated the impact of stress on effectors of the L-arginine/nitric oxide (NO) system including the endogenous inhibitor asymmetric dimethylarginine (ADMA). METHODS Black (n = 168) and white (n = 206) South African teachers were exposed to a mental and a physical stressor for 1 minute, respectively. Serum samples for determination of l-arginine, NO metabolites, ADMA, and symmetric dimethylarginine (SDMA) were obtained at rest and during stress exposure. Perception of task stressfulness was assessed on a 7-point Likert scale, and psychological distress was estimated by the General Health Questionnaire. RESULTS Black South Africans exhibited higher resting levels of NO metabolites (adjusted mean [standard error of the mean] = 11.3 [1.3] versus 3.9 [1.1] μmol/l, p < .001) but lower circulating ADMA (0.62 [0.02] versus 0.70 [0.02] μmol/l, p = .004) and SDMA (0.41 [0.01] versus 0.53 [0.01] μmol/l, p < .001) than did white South Africans. Ethnicity-by-psychological distress interaction was observed for resting levels of ADMA (p = .002), SDMA (p = .038), and L-arginine (p = .048). Ethnic differences in responses to experimental stress were evident for NO metabolites (blacks versus whites: 5.94 [1.55] versus -0.74 [1.25] μmol/l, p = .004) and SDMA (blacks versus whites: -0.02 [0.01] versus 0.02 [0.01] μmol/l, p = .004). Ethnicity-by-psychological distress interaction for stress responses was found for l-arginine/ADMA ratio (p = .027). CONCLUSIONS The l-arginine/NO system is affected by psychosocial distress with higher susceptibility in black South Africans. This interaction may contribute to the higher cardiovascular disease risk in black South Africans.
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Hoebel S, Malan L, De Ridder JH. Determining ethnic-, gender-, and age-specific waist circumference cut-off points to predict metabolic syndrome: the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study. JOURNAL OF ENDOCRINOLOGY, METABOLISM AND DIABETES OF SOUTH AFRICA 2013. [DOI: 10.1080/22201009.2013.10872311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Hoebel
- Physical Activity Sport and Recreation, School of Biokinetics, Recreation and Sport Science North-West University, Potchefstroom Campus
| | - L Malan
- Hypertension in Africa Research Team, School for Physiology, Nutrition and Consumer Sciences North-West University, Potchefstroom Campus
| | - JH De Ridder
- Physical Activity Sport and Recreation, School of Biokinetics, Recreation and Sport Science North-West University, Potchefstroom Campus
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Malan L, Hamer M, Schlaich M, Lambert G, Ziemssen T, Reimann M, Frasure-Smith N, Amirkhan J, Schutte R, van Rooyen J, Mels C, Fourie C, Uys A, Malan N. Defensive coping facilitates higher blood pressure and early sub-clinical structural vascular disease via alterations in heart rate variability: The SABPA study. Atherosclerosis 2013; 227:391-7. [DOI: 10.1016/j.atherosclerosis.2013.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 11/15/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
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Greater cardiovascular reactivity to a cold stimulus is due to higher cold pain perception in black Africans. J Hypertens 2012; 30:2416-24. [DOI: 10.1097/hjh.0b013e328358faf7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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31
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Sex hormones associated with subclinical kidney damage and atherosclerosis in South African men. J Hypertens 2012; 30:2387-94. [DOI: 10.1097/hjh.0b013e3283599bb5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hoebel S, Malan L, de Ridder JH. Determining cut-off values for neck circumference as a measure of the metabolic syndrome amongst a South African cohort: the SABPA study. Endocrine 2012; 42:335-42. [PMID: 22407493 DOI: 10.1007/s12020-012-9642-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
Abstract
The aim was to determine receiver operating characteristic (ROC) neck circumference (NC) cut offs best associated with the metabolic syndrome (MetS) in a South African cohort. We included 409 urban Africans and Caucasians and stratified them into gender and age groups (25-45 years; 45-65 years). Measurements included anthropometric, fasting overnight urine and biological markers for the MetS (systolic and diastolic blood pressure, glucose, triglycerides, and high density lipoprotein). ROC analysis determined pathological (NC) cut-points of 39 and 35 cm for young and older African men; 32 and 35 cm for young and old African women; 40 and 41 cm for Caucasian men; 34 and 33 cm for Caucasian women. Pathological NC cut-points significantly predicted MetS in all ethnic-gender-age groups except in African women (ORs 2.3-5.4; 95% CI 1.36-16.5). Multiple regression analyses revealed that MetS prevalence and ROC cut-points were not associated with renal impairment in any groups. ROC NC cut-points demonstrated that NC may be used as an additional anthropometric marker to predict the MetS in a South African cohort but not in African women.
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Affiliation(s)
- S Hoebel
- Physical Activity Sport and Recreation (PhASRec), School of Biokinetics, Recreation and Sport Science, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
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Malan NT, Hamer M, Schutte AE, Huisman HW, van Rooyen JM, Schutte R, Mels CM, Steyn HS, Smith W, Fourie CM, Glyn M, Malan L. Low Testosterone and Hyperkinetic Blood Pressure Responses in a Cohort of South African Men: The SABPA Study. Clin Exp Hypertens 2012; 35:228-35. [DOI: 10.3109/10641963.2012.721839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Kruger R, Schutte R, Huisman HW, Hindersson P, Olsen MH, Schutte AE. N-terminal Prohormone B-type Natriuretic Peptide and Cardiovascular Function in Africans and Caucasians: The SAfrEIC Study. Heart Lung Circ 2012; 21:88-95. [DOI: 10.1016/j.hlc.2011.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 10/14/2011] [Accepted: 10/28/2011] [Indexed: 11/25/2022]
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Reimann M, Hamer M, Schlaich M, Malan NT, Rüdiger H, Ziemssen T, Malan L. Autonomic responses to stress in Black versus Caucasian Africans: the SABPA study. Psychophysiology 2011; 49:454-61. [PMID: 22176778 DOI: 10.1111/j.1469-8986.2011.01328.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/11/2011] [Indexed: 11/30/2022]
Abstract
Underlying mechanisms of increased pressor responses to stress in Blacks are poorly understood. Cardiovascular regulation of normotensive Black (n=43) and Caucasian (n=90) Africans was studied during a cold pressor and color-word conflict test. Autonomic evaluation was performed by spectral analysis. Higher diastolic pressor and heart rate responses to the cold pressor test were observed in Black compared to Caucasian Africans. Autonomic efferent outflow to stress was comparable between groups. Transient downregulation of baroreflex during stress was evident in Blacks but not in Caucasians. Greater diastolic pressor responses were related to a higher cardiac reactivity, a baroreflex desensitization, and higher stress perception in Black Africans. Thus, increased stress perception may facilitate cardiac and diastolic hyperreactivity, indirectly affecting baroreflex function in Black Africans.
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Affiliation(s)
- Manja Reimann
- Autonomic and Neuroendocrinological Laboratory Dresden, Department of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
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Hamer M, Malan NT, Harvey BH, Malan L. Depressive symptoms and sub-clinical atherosclerosis in Africans: Role of metabolic syndrome, inflammation and sympathoadrenal function. Physiol Behav 2011; 104:744-8. [DOI: 10.1016/j.physbeh.2011.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 07/22/2011] [Indexed: 12/12/2022]
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Zhang Y, Ren J. ALDH2 in alcoholic heart diseases: molecular mechanism and clinical implications. Pharmacol Ther 2011; 132:86-95. [PMID: 21664374 DOI: 10.1016/j.pharmthera.2011.05.008] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 05/13/2011] [Indexed: 01/12/2023]
Abstract
Alcoholic cardiomyopathy is manifested as cardiac hypertrophy, disrupted contractile function and myofibrillary architecture. An ample amount of clinical and experimental evidence has depicted a pivotal role for alcohol metabolism especially the main alcohol metabolic product acetaldehyde, in the pathogenesis of this myopathic state. Findings from our group and others have revealed that the mitochondrial isoform of aldehyde dehydrogenase (ALDH2), which metabolizes acetaldehyde, governs the detoxification of acetaldehyde formed following alcohol consumption and the ultimate elimination of alcohol from the body. The ALDH2 enzymatic cascade may evolve as a unique detoxification mechanism for environmental alcohols and aldehydes to alleviate the undesired cardiac anomalies in ischemia-reperfusion and alcoholism. Polymorphic variants of the ALDH2 gene encode enzymes with altered pharmacokinetic properties and a significantly higher prevalence of cardiovascular diseases associated with alcoholism. The pathophysiological effects of ALDH2 polymorphism may be mediated by accumulation of acetaldehyde and other reactive aldehydes. Inheritance of the inactive ALDH2*2 gene product is associated with a decreased risk of alcoholism but an increased risk of alcoholic complications. This association is influenced by gene-environment interactions such as those associated with religion and national origin. The purpose of this review is to recapitulate the pathogenesis of alcoholic cardiomyopathy with a special focus on ALDH2 enzymatic metabolism. It will be important to dissect the links between ALDH2 polymorphism and prevalence of alcoholic cardiomyopathy, in order to determine the mechanisms underlying such associations. The therapeutic value of ALDH2 as both target and tool in the management of alcoholic tissue damage will be discussed.
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Affiliation(s)
- Yingmei Zhang
- Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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