1
|
Doumatey AP, Bentley AR, Akinyemi R, Olanrewaju TO, Adeyemo A, Rotimi C. Genes, environment, and African ancestry in cardiometabolic disorders. Trends Endocrinol Metab 2023; 34:601-621. [PMID: 37598069 PMCID: PMC10548552 DOI: 10.1016/j.tem.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023]
Abstract
The past two decades have been characterized by a substantial global increase in cardiometabolic diseases, but the prevalence and incidence of these diseases and related traits differ across populations. African ancestry populations are among the most affected yet least included in research. Populations of African descent manifest significant genetic and environmental diversity and this under-representation is a missed opportunity for discovery and could exacerbate existing health disparities and curtail equitable implementation of precision medicine. Here, we discuss cardiometabolic diseases and traits in the context of African descent populations, including both genetic and environmental contributors and emphasizing novel discoveries. We also review new initiatives to include more individuals of African descent in genomics to address current gaps in the field.
Collapse
Affiliation(s)
- Ayo P Doumatey
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training and Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Timothy O Olanrewaju
- Division of Nephrology, Department of Medicine, University of Ilorin & University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Charles Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| |
Collapse
|
2
|
Lala V, Tikly M, Musenge E, Govind N. Comorbidities in Black South Africans with established rheumatoid arthritis. Int J Rheum Dis 2022; 25:699-704. [PMID: 35505588 PMCID: PMC9321589 DOI: 10.1111/1756-185x.14328] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/26/2022] [Accepted: 04/17/2022] [Indexed: 01/03/2023]
Abstract
Objective Comorbidities contribute both to morbidity and mortality in rheumatoid arthritis (RA). The aim of the current study was to investigate the prevalence and spectrum of comorbidities in South Africans with established RA. Methods A retrospective, consecutive case record review of 500 Black South African patients with established disease of ≥5 years attending a tertiary rheumatology service was performed. Common comorbidities including those listed in the Charlson Comorbidity Score (CCS) were documented. Results Most patients, 463 known alive (AG) and 37 known deceased (DG), were female (87%). Mean (SD) age and disease duration were 60 (11.1) and 10.7 (5.0) years respectively, and 98% had ≥1 comorbidities. Median CCS was 2, significantly higher in DG than AG (4 vs 2, P < .0001). Despite hypertension (70%) and hypercholesterolemia (47%) being the commonest comorbidities overall and type 2 diabetes (T2D) occurring in 15.4%, clinical cardiovascular events were rare (0.6%). Peptic ulcer disease (odds ratio [OR] = 8.67), congestive cardiac failure (OR = 7.09), serious infections (OR = 7.02) and tuberculosis (OR = 2.56) were significantly more common in DG than AG. Multivariate analysis showed that American College of Rheumatology functional class 3/4 was associated with increased risk for serious infections (OR = 3.84) and tuberculosis (OR = 2.10). Conclusion Despite the high burden of cardiometabolic comorbidities in South Africans with established RA, cardiovascular events were rare. Serious infections and tuberculosis, both associated with severe functional disability, are a major cause of morbidity and mortality.
Collapse
Affiliation(s)
- Vikash Lala
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammed Tikly
- Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Nimmisha Govind
- Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
3
|
Difficulty of falling asleep and non-high-density lipoprotein cholesterol level among Canadian older adults: a cross-sectional analysis of the Canadian Longitudinal Study for Aging baseline data. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:597-608. [PMID: 34527026 PMCID: PMC8390930 DOI: 10.11909/j.issn.1671-5411.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine whether difficulty of falling asleep (DoFA) is associated with non-high-density lipoprotein cholesterol (non-HDL-C) level among Canadian older adults. METHODS 26,954 individuals aged 45–85 years from the baseline data of the Canadian Longitudinal Study for Aging were included in this study. DoFA was categorized into five groups by answer to the question “Over the last month, how often did it take you more than 30 min to fall asleep?” Response options are “Never, < 1 time/week, 1−2 times/week, 3−5 times/week, or 6−7 times/week”. Non-HDL-C, the difference of total cholesterol and HDL-C, were categorized into five categories based on these cut-offs (< 2.6 mmol/L, 2.6−3.7 mmol/L, 3.7−4.8 mmol/L, 4.8−5.7 mmol/L, and ≥ 5.7 mmol/L). Ordinal logistic regression (logit link) continuation ratio models were used to estimate the odds of higher non-HDL-C levels for DoFA status. Adjusted means of non-HDL-C by DoFA status were estimated by general linear models. All analyses were sex separately using analytic weights to ensure generalizability. RESULTS The proportions of DoFA in five categories were 41.6%, 25.7%, 13.6%, 9.4%, 9.7% for females and 52.9%, 24.9%, 10.5%, 6.1%, 5.6% for males, respectively. After adjustment of demographical and other covariates (such as depression, comorbidity, sleeping hour, etc.) compared to those who reported never having DoFA, the ORs (95% CIs) of higher levels of non-HDL-C for those whose DoFA status in < 1 time/week, 1−2 times/week, 3−5 times/week, and 6−7 times/week were 1.12 (1.05−1.21), 1.09 (0.99−1.18), 1.20 (1.09−1.33), 1.29 (1.17−1.43) in females and 1.05 (0.98−1.13), 0.95 (0.87−1.05), 1.21 (1.08−1.37), 0.97 (0.85−1.09) in males, respectively. The adjusted means of non-HDL-C among the five DoFA status were 3.68 mmol/L, 3.73 mmol/L, 3.74 mmol/L, 3.82 mmol/L, 3.84 mmol/L for females and 3.54 mmol/L, 3.58 mmol/L, 3.51 mmol/L, 3.69 mmol/L, 3.54 mmol/L for males, respectively. CONCLUSIONS The results of this study have identified a risk association pattern between DoFA status and non-HDL-C levels in females but not in males. Further research is needed to confirm these findings.
Collapse
|
4
|
Dlamini SN, Choudhury A, Ramsay M, Micklesfield LK, Norris SA, Crowther NJ, Crawford AA, Walker BR, Lombard Z, Goedecke JH. Associations Between CYP17A1 and SERPINA6/A1 Polymorphisms, and Cardiometabolic Risk Factors in Black South Africans. Front Genet 2021; 12:687335. [PMID: 34484290 PMCID: PMC8414563 DOI: 10.3389/fgene.2021.687335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/20/2021] [Indexed: 01/11/2023] Open
Abstract
Research in European and Asian populations has reported associations between single nucleotide polymorphisms (SNPs) in CYP17A1 and SERPINA6/A1 and circulating glucocorticoid concentrations, and some key cardiometabolic risk factors. This study aimed to investigate these associations in black South African adults, who are disproportionally affected by the metabolic syndrome and its related cardiometabolic risk factors. The dataset included black South African adults (n = 4,431; 56.7% women) from the AWI-Gen study, genotyped on the H3A genotyping array and imputed using the African reference panel at the Sanger imputation service. From the imputed data, 31 CYP17A1 SNPs and 550 SERPINA6/A1 SNPs were extracted. The metabolic syndrome and its components were defined using the 2009 harmonized guidelines. Serum glucocorticoid concentrations were measured in a subset of 304 men and 573 women, using a liquid chromatography-mass spectrometry method. Genetic associations were detected using PLINK. Bonferroni correction was used to control for multiple testing. A SNP at SERPINA6/A1, rs17090691 (effect allele G), was associated with higher diastolic blood pressure (BP) in all adults combined (p = 9.47 × 10-6). Sex-stratified analyses demonstrated an association between rs1051052 (effect allele G), another SERPINA6/A1 SNP, and higher high-density lipoprotein (HDL) cholesterol concentrations in women (p = 1.23 × 10-5). No association was observed between these variants and glucocorticoids or between any of the CYP17A1 SNPs and metabolic outcomes after adjusting for multiple testing. Furthermore, there were no associations between any of the SNPs tested and the metabolic syndrome. This study reports novel genetic associations between two SNPs at SERPINA6/A1 and key cardiometabolic risk factors in black South Africans. Future replication and functional studies in larger populations are required to confirm the role of the identified SNPs in the metabolic syndrome and assess if these associations are mediated by circulating glucocorticoids.
Collapse
Affiliation(s)
- Siphiwe N. Dlamini
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ananyo Choudhury
- Faculty of Health Sciences, Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Michèle Ramsay
- Faculty of Health Sciences, Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K. Micklesfield
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J. Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew A. Crawford
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Brian R. Walker
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Zané Lombard
- Division of Human Genetics, National Health Laboratory Service, Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Julia H. Goedecke
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| |
Collapse
|
5
|
Liu J, Son S, Giancaterino M, Verschoor CP, Narushima M. Non-HDL cholesterol level and depression among Canadian elderly—a cross-sectional analysis of the baseline data from the CLSA. Facets (Ott) 2020. [DOI: 10.1139/facets-2020-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To explore whether non-high-density-lipoprotein cholesterol (non-HDL-c) is associated with depression, a total of 26 819 Canadians aged 45–85 from the Canadian Longitudinal Study on Aging (CLSA) were included in analysis. Non-HDL-c, the difference between total-c and HDL-c, was categorized into five levels, i.e., <2.6, 2.6 to <3.7, 3.7 to <4.8, 4.8 to 5.7, and ≥5.7 mmol/L. History of clinical depression was collected by questionnaire at an in-home interview, and current potential depression status was determined by CES-D10 (Center for Epidemiological Studies Depression Scale 10 questions version) score, i.e., ≥10 vs. <10. Logistic continuation ratio model for ordinal data was used to estimate the odds of being at or above a higher non-HDL-c category for depression status. Compared with those without clinical depression history and currently undepressed, the adjusted odds ratios (95% CI) were 1.09 (1.02, 1.17) for those without clinical depression history but currently depressed, 1.05 (0.98, 1.12) for those had clinical depression history but currently undepressed, and 1.21 (1.10, 1.32) for those had clinical depression history and currently depressed. The average of non-HDL-c for four depression groups were 3.64, 3.71, 3.69, and 3.82 mmol/L, respectively, and group 4 was statistically higher than others ( p < 0.001). In conclusion, people with both current depression and a history clinical depression are at an increased risk of having high level of non-HDL-c.
Collapse
Affiliation(s)
- Jian Liu
- Department of Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Surim Son
- Department of Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Mike Giancaterino
- Department of Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada
| | | | - Miya Narushima
- Department of Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada
| |
Collapse
|
6
|
Kavishe B, Vanobberghen F, Katende D, Kapiga S, Munderi P, Baisley K, Biraro S, Mosha N, Mutungi G, Mghamba J, Hughes P, Smeeth L, Grosskurth H, Peck R. Dyslipidemias and cardiovascular risk scores in urban and rural populations in north-western Tanzania and southern Uganda. PLoS One 2019; 14:e0223189. [PMID: 31809516 PMCID: PMC6897412 DOI: 10.1371/journal.pone.0223189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/16/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Dyslipidemia is a leading risk factor for atherosclerotic cardiovascular disease. There are few published epidemiological data regarding dyslipidemia in Africa. We determined full lipid and apolipoprotein profiles and investigated factors associated with lipid levels in urban and rural populations of north-western Tanzania and southern Uganda. METHODS We conducted a cross-sectional survey of randomly-selected, community-dwelling adults (≥18yrs) including five strata per country: one municipality, two district towns and two rural areas. Participants were interviewed and examined using the World Health Organization STEPwise survey questionnaire. Serum levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and apolipoproteins were measured. Factors associated with mean lipid levels were assessed by multivariable linear regression. Framingham 10-year cardiovascular risk scores were calculated with and without lipids. RESULTS One-third of adults in the study population had dyslipidemia. Low high-density lipoprotein cholesterol affected 32-45% of rural adults. High total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B were found in <15% of adult population in all strata, but were more common in urban adults. Factors independently associated with higher mean low-density lipoprotein cholesterol and apolipoprotein B were female gender, older age, higher education, higher income, obesity, and hypertension. Framingham cardiovascular risk scores with and without lipids yielded similar results and 90% of study subjects in all strata were classified as "low risk". Among older adults (>55 years), 30% were classified as "high" or "very high" risk. CONCLUSIONS Dyslipidemias are common among adults in north-western Tanzania and southern Uganda affecting one third of adult population. Overall, cardiovascular risk scores are low but high risk scores are common with older adults. Health services designed and equipped to diagnose and treat dyslipidemia are urgently needed.
Collapse
Affiliation(s)
- Bazil Kavishe
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Fiona Vanobberghen
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David Katende
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paula Munderi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Kathy Baisley
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Samuel Biraro
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Neema Mosha
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Janneth Mghamba
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Tanzania
| | - Peter Hughes
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | - Liam Smeeth
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Heiner Grosskurth
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robert Peck
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Weill Bugando School of Medicine, Mwanza, Tanzania
- Weill Cornell Medical College, New York, NY, United States of America
| |
Collapse
|
7
|
de Sousa ELH, Cavalcante JEA, de Sousa DF, Ferreira JM, Meneses RRC, Sousa DL, da Silva AJX, Filho RRBX, da Silva Dos Santos E, Havt A, Damasceno NRT, Sampaio TL, Queiroz MGR. Comparison of early cardiovascular risk among Brazilian and African university students. Clin Biochem 2019; 75:7-14. [PMID: 31678428 DOI: 10.1016/j.clinbiochem.2019.09.007] [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: 07/09/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 12/25/2022]
Abstract
Cardiovascular diseases are among the main causes of mortality worldwide, and dyslipidemia is a principal factor risk. Hence the study of biochemical markers is necessary for early diagnosis. OBJECTIVES Evaluate biomarkers to diagnose the risks of cardiovascular diseases in healthy Brazilian and African young adults. DESIGN & METHODS Weight, height, waist circumference, percentage of body fat and systemic blood pressure were measured; and fasting blood samples were taken for biochemical analysis. Triglycerides, total cholesterol, HDL-c, and apolipoproteins A-I and B were measured on automated equipment using commercially available kits, in addition to the tests of antioxidant capacity of HDL and the enzymatic activity of Paraoxonase 1. RESULTS After statistical analysis, it was found that BMI, WC, fat (%), triglycerides, ApoB/ApoA-I ratio and Vmax were higher in Brazilians, while HDL-c, ApoA-I, Lag Time, Vmax and PON1 activity were higher in Africans. In Brazilians, the ApoB/ApoA-I ratio was related to obesity factors and lipid profile, but in Africans it was related only to lipids. The antioxidant capacity of HDL and PON1 activity was better in Africans. Through independence testing, we observed an association with moderate risk of myocardial infarction with gender in Africans. In the binary logistic regression analysis, it was found that men in general - and particularly African men - have higher risk of myocardial infarction than women; Odds Ratio 2144 (CI95%: 1343-3424) and 2281 (CI95%: 1082-4811), respectively. CONCLUSIONS The anthropometric and biochemical parameters of Brazilians, especially men, predispose them to greater risks of cardiovascular diseases.
Collapse
Affiliation(s)
| | | | | | | | | | - Duaran Lopes Sousa
- Department of Clinical and Toxicological Analysis, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Elias da Silva Dos Santos
- Department of Clinical and Toxicological Analysis, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alexandre Havt
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Tiago Lima Sampaio
- Department of Clinical and Toxicological Analysis, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | | |
Collapse
|
8
|
Smith W, Kotliar KE, Lammertyn L, Ramoshaba NE, Vilser W, Huisman HW, Schutte AE. Retinal vessel caliber and caliber responses in true normotensive black and white adults: The African-PREDICT study. Microvasc Res 2019; 128:103937. [PMID: 31644892 DOI: 10.1016/j.mvr.2019.103937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/20/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Globally, a detrimental shift in cardiovascular disease risk factors and a higher mortality level are reported in some black populations. The retinal microvasculature provides early insight into the pathogenesis of systemic vascular diseases, but it is unclear whether retinal vessel calibers and acute retinal vessel functional responses differ between young healthy black and white adults. METHODS We included 112 black and 143 white healthy normotensive adults (20-30 years). Retinal vessel calibers (central retinal artery and vein equivalent (CRAE and CRVE)) were calculated from retinal images and vessel caliber responses to flicker light induced provocation (FLIP) were determined. Additionally, ambulatory blood pressure (BP), anthropometry and blood samples were collected. RESULTS The groups displayed similar 24 h BP profiles and anthropometry (all p > .24). Black participants demonstrated a smaller CRAE (158 ± 11 vs. 164 ± 11 MU, p < .001) compared to the white group, whereas CRVE was similar (p = .57). In response to FLIP, artery maximal dilation was greater in the black vs. white group (5.6 ± 2.1 vs. 3.3 ± 1.8%; p < .001). CONCLUSIONS Already at a young age, healthy black adults showed narrower retinal arteries relative to the white population. Follow-up studies are underway to show if this will be related to increased risk for hypertension development. The reason for the larger vessel dilation responses to FLIP in the black population is unclear and warrants further investigation.
Collapse
Affiliation(s)
- Wayne Smith
- Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Konstantin E Kotliar
- Department of Biomedical Engineering and Technomathematics, Aachen University of Applied Sciences, Juelich, Germany
| | - Leandi Lammertyn
- Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Nthai E Ramoshaba
- Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | | | - Hugo W Huisman
- Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa; Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| |
Collapse
|
9
|
Birk R, Heifetz EM. Variations in biochemical values for common laboratory tests: a comparison among multi-ethnic Israeli women cohort. Ir J Med Sci 2019; 188:249-258. [PMID: 29705948 DOI: 10.1007/s11845-018-1825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Biochemical laboratory values are an essential tool in medical diagnosis, treatment, and follow-up; however, they are known to vary between populations. Establishment of ethnicity-adjusted reference values is recommended by health organizations. AIM To investigate the ethnicity element in biochemical lab values studying women of different ethnic groups. METHODS Biochemical lab values (n = 27) of 503 adult Israeli women of three ethnicities (Jewish Ashkenazi, Jewish Sephardic, and Bedouin Arab) attending a single medical center were analyzed. Biochemical data were extracted from medical center records. Ethnic differences of laboratory biochemicals were studied using ANCOVA to analyze the center of the distribution as well as quartile regression analysis to analyze the upper and lower limits, both done with an adjustment for age. RESULTS Significant ethnic differences were found in almost half (n = 12) of the biochemical laboratory tests. Ashkenazi Jews exhibited significantly higher mean values compared to Bedouins in most of the biochemical tests, including albumin, alkaline phosphatase, calcium, cholesterol, cholesterol LDL and HDL, cholesterol LDL calc., folic acid, globulin, and iron saturation, while the Bedouins exhibited the highest mean values in the creatinine and triglycerides. For most of these tests, Sephardic Jews exhibited biochemical mean levels in between the two other groups. Compared to Ashkenazi Jews, Sephardic Jews had a significant shift to lower values in cholesterol LDL. CONCLUSIONS Ethnic subpopulations have distinct distributions in biochemical laboratory test values, which should be taken into consideration in medical practice enabling precision medicine.
Collapse
Affiliation(s)
- Ruth Birk
- Department of Nutrition, Faculty of Health Sciences, Ariel University, 40700, Ariel, Israel.
| | - Eliyahu M Heifetz
- Faculty of Health Sciences, Jerusalem College of Technology, Jerusalem, Israel
| |
Collapse
|
10
|
Pantoja-Torres B, Toro-Huamanchumo CJ, Urrunaga-Pastor D, Guarnizo-Poma M, Lazaro-Alcantara H, Paico-Palacios S, Del Carmen Ranilla-Seguin V, Benites-Zapata VA. High triglycerides to HDL-cholesterol ratio is associated with insulin resistance in normal-weight healthy adults. Diabetes Metab Syndr 2019; 13:382-388. [PMID: 30641729 DOI: 10.1016/j.dsx.2018.10.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/09/2018] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the association between high triglyceride/HDL-cholesterol (TG/HDL-C) ratio and insulin resistance (IR) or hyperinsulinemia after oral glucose tolerance test (OGTT) in normal-weight healthy adults. METHODS We carried out an analytical cross-sectional study in euthyroid non-diabetic adults, who attended the outpatient service of a private clinic in Lima-Peru from 2012 to 2016. Participants were divided in two groups according to the presence or absence of high TG/HDL-C ratio, IR or hyperinsulinemia after OGTT. TG/HDL-C ratio values ≥ 3 were considered as high. IR was defined as a Homeostasis Model Assessment (HOMA-IR) value ≥ 2.28 and hyperinsulinemia after OGTT as a serum insulin value ≥ 80μU/mL after 120 min of 75-g glucose intake. We elaborated crude and adjusted Poisson generalized linear models to evaluate the association between high TG/HDL-C ratio and IR or hyperinsulinemia after OGTT and reported the prevalence ratio (PR) with their respective 95% confidence intervals (95%CI). RESULTS We analyzed the data of 118 individuals. Prevalence of high TG/HDL-C ratio was 17.8% (n = 21) while the prevalence of IR and hyperinsulinemia after OGTT was 24.6% (n = 29) and 17.0% (n = 20), respectively. TG/HDL-C-ratio values were positively correlated with HOMA-IR (r = 0.498; p < 0.01) and serum insulin after OGTT (r = 0.326; p < 0.001). In the adjusted model, high TG/HDL-C ratio was associated with both IR (aPR = 3.16; 95%CI: 1.80-5.77) and hyperinsulinemia after OGTT (aPR = 2.36; 95%CI: 1.20-4.63). CONCLUSIONS High TG/HDL-C ratio was associated with both IR markers used in our study, appearing to be a clinically useful tool to assess IR in euthyroid normal-weight adults without type 2 diabetes mellitus.
Collapse
Affiliation(s)
| | - Carlos J Toro-Huamanchumo
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.
| | - Diego Urrunaga-Pastor
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.
| | | | | | | | | | - Vicente A Benites-Zapata
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.
| |
Collapse
|
11
|
Peer N, Balakrishna Y, de Villiers A, Naidoo P. Differential associations of cardio-metabolic diseases by population group, gender and adiposity in South Africa. PLoS One 2018; 13:e0202899. [PMID: 30260983 PMCID: PMC6160009 DOI: 10.1371/journal.pone.0202899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/11/2018] [Indexed: 12/29/2022] Open
Abstract
Aims To describe the distribution and examine the associations of diabetes, hypertension and hypercholesterolaemia across and within population groups, gender and body mass index (BMI) categories. Methods This national cross-sectional study was conducted in 2013 among ≥18-year-old black African, coloured, white and Indian adults self-selected for screening. Data collection included self-reported behavioural risk factors and clinical measurements comprising blood pressure, anthropometry and point-of-care random blood glucose and cholesterol assessments. Results Among the 7711 participants, 2488 men and 5223 women, the prevalence of diabetes and hypertension increased by BMI category across population groups. Compared with white men and women, black African men (odds ratio: 2.66, 95% confidence interval: 1.70–4.16) and women (2.10, 1.49–2.96), coloured men (2.28, 1.44–3.60) and women (2.15, 1.52–3.05) and Indian men (4.38, 2.65–7.26) and women (3.64, 2.50–5.32) were significantly more likely to have diabetes. The odds for hypertension were significantly higher only in coloured men compared with white men (1.37, 1.02–1.83), while it was significantly higher in black African, coloured and Indian women compared with white women. The odds for hypercholesterolaemia were significantly lower in black African men (0.64, 0.49–0.84) and women (0.52, 0.43–0.62) compared with white men and women, and significantly higher in Indian men (1.47, 1.05–2.08) compared with white men. Black African women compared with their male counterparts were less likely to have diabetes (0.64, 0.46–0.89). Black African (0.66, 0.54-.082), coloured (0.65, 0.50–0.84) and white (0.69, 0.53–0.88) women were significantly less likely to have hypertension compared with their male counterparts. The odds for hypercholesterolaemia were higher in coloured (1.44, 1.16–1.80) and white (1.47, 1.18–1.84) women compared with their counterparts. Conclusions The cardio-metabolic diseases of diabetes, hypertension and hypercholesterolaemia were differentially associated with population groups and gender in South Africa. The insights obtained highlight the need for multi-disciplinary targeted management approaches in high-risk populations.
Collapse
Affiliation(s)
- Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Anniza de Villiers
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Pamela Naidoo
- Heart and Stroke Foundation South Africa, Cape Town, South Africa
- Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
12
|
Avocado Fruit on Postprandial Markers of Cardio-Metabolic Risk: A Randomized Controlled Dose Response Trial in Overweight and Obese Men and Women. Nutrients 2018; 10:nu10091287. [PMID: 30213052 PMCID: PMC6164649 DOI: 10.3390/nu10091287] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 08/29/2018] [Accepted: 09/08/2018] [Indexed: 12/24/2022] Open
Abstract
Avocados are distinctive fruits having both fats and fibers along with various micronutrients and bioactive phytochemicals. This study aimed to assess the effects of replacing carbohydrate energy in meals with half or whole avocado on postprandial indices of metabolic and vascular health. A single-center, randomized, controlled, 3-arm, 6 h, crossover study was conducted in overweight/obese middle-aged adults (n = 31). Participants consumed energy-matched breakfast meals containing 0 g (Control), 68 g (Half-A) or 136 g (Whole-A) fresh Hass avocado on 3 separate occasions. Post-meal glycemic (p < 0.0001), insulinemic (p < 0.0001) and flow mediated vasodilation (FMD) responses were reduced compared to Control meal (p < 0.01), independent of dose. Nuclear magnetic resonance analyses indicated lower concentrations of triglyceride-rich lipoproteins and higher concentrations of larger high-density lipoprotein (HDL) particles after the Whole-A vs. the Control meal (p = 0.02, p < 0.05, respectively). Race/ethnicity influenced sub-class lipoprotein concentrations (p < 0.05). Oxidized low-density-lipoproteins, monocyte chemoattractant protein-1, and interleukin-6 were not different among meals. Tumor necrosis factor-α tended to be lower after Whole-A vs. Control meal (p = 0.07). Replacing carbohydrate components with avocados in a meal improved FMD, a measure of endothelial function, and improved glycemic and lipoprotein profiles in overweight/obese adults. The study provides insight on the acute cardio-metabolic benefits of incorporating avocados into a meal.
Collapse
|
13
|
Ramteke SM, Shiau S, Foca M, Strehlau R, Pinillos F, Patel F, Violari A, Liberty A, Coovadia A, Kuhn L, Arpadi SM. Patterns of Growth, Body Composition, and Lipid Profiles in a South African Cohort of Human Immunodeficiency Virus-Infected and Uninfected Children: A Cross-Sectional Study. J Pediatric Infect Dis Soc 2018; 7:143-150. [PMID: 28481997 PMCID: PMC5954242 DOI: 10.1093/jpids/pix026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/14/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Prior research in sub-Saharan Africa reports dyslipidemia in perinatally human immunodeficiency virus (HIV)-infected children receiving ritonavir-boosted lopinavir (LPV/r) compared with efavirenz; however, interpretation of findings is limited by lack of comparison data from HIV-uninfected children. METHODS We conducted a cross-sectional analysis of lipid profiles and growth within a larger longitudinal cohort study of perinatally HIV-infected and HIV-uninfected children aged 4-9 years in Johannesburg, South Africa. At enrollment, anthropometrics, viral load, CD4, total cholesterol (TC), high-density lipoprotein, low-density lipoprotein (LDL), and triglycerides were measured. Weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), and body mass index-for-age Z-score (BAZ) were calculated. United States pediatric thresholds for dyslipidemia were used. RESULTS Five hundred fifty-three HIV-infected and 300 HIV-uninfected children (median age 6.9 years) of similar demographic characteristics were enrolled. Of the HIV-infected children, 94.8% were on combination antiretroviral therapy (cART) (65.4% on LPV/r- and 28.6% on efavirenz-based regimens). Among the treated, 94.3% had a viral load <200 copies/mL. Median CD4% was 34.4. The HIV-infected children had lower mean WAZ (-0.7 vs -0.3, P < .01) and HAZ (-1.1 vs -0.7, P < .01) compared with HIV-uninfected children. A lower proportion of HIV-infected children were overweight (BAZ >1) compared with HIV-uninfected children (14.4% vs 21.7%, P = .04). Whether on LPV/r or efavirenz, a higher proportion of HIV-infected children had borderline/elevated TC or abnormal triglycerides than HIV-uninfected children, although a higher proportion of those on LPV/r had borderline/elevated TC, borderline/elevated LDL, or abnormal triglycerides than those on efavirenz. CONCLUSIONS In a South African cohort of HIV-infected children and population-appropriate HIV-uninfected children, unfavorable alterations in lipid profiles were detected in HIV-infected children regardless of treatment regimen compared with HIV-uninfected children. The HIV-infected children were of smaller size than HIV-uninfected children, but there was a high prevalence of overweight in both groups. Strategies for optimizing growth and early life management of lipid alterations may be warranted.
Collapse
Affiliation(s)
- Sarah M Ramteke
- Gertrude H. Sergievsky Center, Columbia University, New York
| | - Stephanie Shiau
- Gertrude H. Sergievsky Center, Columbia University, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York,Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marc Foca
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francoise Pinillos
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Faeezah Patel
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, Columbia University, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York,Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Arpadi
- Gertrude H. Sergievsky Center, Columbia University, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York,Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York,Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa,Correspondence: S. M. Arpadi, MD, MS, Gertrude H. Sergievsky Center, Columbia University, 622 W. 168th Street, PH 19—114, New York, NY 10032 ()
| | | |
Collapse
|
14
|
Bentley AR, Rotimi CN. Interethnic Differences in Serum Lipids and Implications for Cardiometabolic Disease Risk in African Ancestry Populations. Glob Heart 2017; 12:141-150. [PMID: 28528248 PMCID: PMC5582986 DOI: 10.1016/j.gheart.2017.01.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 12/12/2022] Open
Abstract
African Americans generally have a healthier lipid profile (lower triglycerides and higher high-density lipoprotein cholesterol concentration) compared with those of other ethnicities. Paradoxically, African Americans do not experience a decreased risk of the cardiometabolic diseases that serum lipids are expected to predict. This review explores this mismatch between biomarker and disease among African ancestry individuals by investigating the presence of interethnic differences in the biological relationships underlying the serum lipids-disease association. This review also discusses the physiologic and genomic factors underlying these interethnic differences. Additionally, because of the importance of serum lipids in assessing disease risk, interethnic differences in serum lipids have implications for identifying African ancestry individuals at risk of cardiometabolic disease. Where possible, data from Africa is included, to further elucidate these ancestral differences in the context of a different environmental background.
Collapse
Affiliation(s)
- Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
15
|
Woudberg NJ, Goedecke JH, Lecour S. Protection from Cardiovascular Disease Due to Increased High-Density Lipoprotein Cholesterol in African Black Populations: Myth or Reality? Ethn Dis 2016; 26:553-560. [PMID: 27773983 PMCID: PMC5072485 DOI: 10.18865/ed.26.4.553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The burden of cardiovascular disease (CVD) in sub-Saharan Africa has increased over the last decade. Despite this, African Black populations present with relatively low incidences of coronary heart disease and ischemic heart disease, which may be attributed to their lower total cholesterol, triglycerides and low-density lipoprotein cholesterol concentrations, compared with White populations. Commensurate with these lower lipid levels, it was believed that high-density lipoprotein cholesterol (HDL-C) concentrations would be higher in Black populations compared with their White counterparts. This is based on data from previous studies of African and African American populations; however, recent studies conducted in Africa found similar or lower HDL-C concentrations in Black compared with White individuals. Current research, therefore, suggests that HDL-C may not be a good indicator of cardiovascular risk and future research should focus on HDL quality (vs quantity), by measuring HDL functionality and subclass.
Collapse
Affiliation(s)
- Nicholas J. Woudberg
- Hatter Institute for Cardiovascular Research in Africa and South African Medical Research Council Inter-University Cape Heart Group, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julia H. Goedecke
- Non-Communicable Disease Research Unit, South African Medical Research Council
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa and South African Medical Research Council Inter-University Cape Heart Group, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
16
|
Keswell D, Tootla M, Goedecke JH. Associations between body fat distribution, insulin resistance and dyslipidaemia in black and white South African women. Cardiovasc J Afr 2016; 27:177-183. [PMID: 27224872 PMCID: PMC5101472 DOI: 10.5830/cvja-2015-088] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/14/2015] [Indexed: 02/01/2023] Open
Abstract
Aim The aim was to examine differences in body fat distribution between premenopausal black and white South African (SA) women and explore the ethnic-specific associations with cardiometabolic risk. Methods Body composition, using dual-energy X-ray absorptiometry (DXA) and computerised tomography, insulin resistance (HOMA-IR) and lipid levels were assessed in 288 black and 197 white premenopausal SA women. Results: Compared to the white women, black women had less central and more peripheral (lower-body) fat, and lower serum lipid and glucose concentrations, but similar homeostasis models for insulin resistance (HOMA-IR) values. The associations between body fat distribution and HOMA-IR, triglyceride and high-density lipoprotein cholesterol concentrations were similar, while the associations with fasting glucose, total and low-density lipoprotein cholesterol levels differed between black and white women. Conclusion: Ethnic differences in body fat distribution are associated, in part, with differences in cardiometabolic risk between black and white SA women.
Collapse
Affiliation(s)
- Dheshnie Keswell
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Mehreen Tootla
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Julia H Goedecke
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa; Non-communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| |
Collapse
|
17
|
Woudberg NJ, Goedecke JH, Blackhurst D, Frias M, James R, Opie LH, Lecour S. Association between ethnicity and obesity with high-density lipoprotein (HDL) function and subclass distribution. Lipids Health Dis 2016; 15:92. [PMID: 27169717 PMCID: PMC4866302 DOI: 10.1186/s12944-016-0257-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity and low high-density lipoprotein-cholesterol (HDL-C) levels are associated with cardiovascular risk. Surprisingly, despite a greater prevalence of obesity and lower HDL concentrations than white women, black South African women are relatively protected against ischaemic heart disease. METHODS We investigated whether this apparent discrepancy may be related to different HDL function and subclass distribution in black and white, normal-weight and obese South African women (n = 40). HDL functionality was assessed by measuring paraoxonase (PON) activity, platelet activating factor acetylhydrolase (PAF-AH) activity, Oxygen Radical Absorbance Capacity (ORAC) and quantification of the expression of vascular cell adhesion molecule in endothelial cells. PON-1 and PAF-AH expression was determined in isolated HDL and serum using Western blotting. Levels of large, intermediate and small HDL subclasses were measured using the Lipoprint® system. RESULTS PON activity was lower in white compared to black women (0.49 ± 0.09 U/L vs 0.78 ± 0.10 U/L, p < 0.05), regardless of PON-1 protein levels. Obese black women had lower PAF-AH activity (9.34 ± 1.15 U/L vs 13.89 ± 1.21 U/L, p <0.05) and HDL-associated PAF-AH expression compared to obese white women. Compared to normal-weight women, obese women had lower large HDL, greater intermediate and small HDL; an effect that was more pronounced in white women than black women. There were no differences in antioxidant capacity or anti-inflammatory function across groups. CONCLUSIONS Our data show that both obesity and ethnicity are associated with differences in HDL functionality, while obesity was associated with decreases in large HDL subclass distribution. Measuring HDL functionality and subclass may, therefore, be important factors to consider when assessing cardiovascular risk.
Collapse
Affiliation(s)
- Nicholas J Woudberg
- Department of Medicine, Hatter Institute for Cardiovascular Research in Africa and South African Medical Research Council Inter-University Cape Heart Group, Faculty of Health Sciences, University of Cape Town, Chris Barnard Building, Anzio Road, Observatory, 7925, Cape Town, Western Cape, South Africa.
| | - Julia H Goedecke
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Dee Blackhurst
- Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Miguel Frias
- Department of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Richard James
- Department of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lionel H Opie
- Department of Medicine, Hatter Institute for Cardiovascular Research in Africa and South African Medical Research Council Inter-University Cape Heart Group, Faculty of Health Sciences, University of Cape Town, Chris Barnard Building, Anzio Road, Observatory, 7925, Cape Town, Western Cape, South Africa
| | - Sandrine Lecour
- Department of Medicine, Hatter Institute for Cardiovascular Research in Africa and South African Medical Research Council Inter-University Cape Heart Group, Faculty of Health Sciences, University of Cape Town, Chris Barnard Building, Anzio Road, Observatory, 7925, Cape Town, Western Cape, South Africa
| |
Collapse
|
18
|
Commodore-Mensah Y, Hill M, Allen J, Cooper LA, Blumenthal R, Agyemang C, Himmelfarb CD. Sex Differences in Cardiovascular Disease Risk of Ghanaian- and Nigerian-Born West African Immigrants in the United States: The Afro-Cardiac Study. J Am Heart Assoc 2016; 5:e002385. [PMID: 26896477 PMCID: PMC4802474 DOI: 10.1161/jaha.115.002385] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 01/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The number of African immigrants in the United States grew 40-fold between 1960 and 2007, from 35 355 to 1.4 million, with a large majority from West Africa. This study sought to examine the prevalence of cardiovascular disease (CVD) risk factors and global CVD risk and to identify independent predictors of increased CVD risk among West African immigrants in the United States. METHODS AND RESULTS This cross-sectional study assessed West African (Ghanaian and Nigerian) immigrants aged 35-74 years in the Baltimore-Washington metropolitan area. The mean age of participants was 49.5±9.2 years, and 58% were female. The majority (95%) had ≥1 of the 6 CVD risk factors. Smoking was least prevalent, and overweight or obesity was most prevalent, with 88% having a body mass index (in kg/m(2)) ≥25; 16% had a prior diagnosis of diabetes or had fasting blood glucose levels ≥126 mg/dL. In addition, 44% were physically inactive. Among women, employment and health insurance were associated with odds of 0.09 (95% CI 0.033-0.29) and 0.25 (95% CI 0.09-0.67), respectively, of having a Pooled Cohort Equations estimate ≥7.5% in the multivariable logistic regression analysis. Among men, higher social support was associated with 0.90 (95% CI 0.83-0.98) lower odds of having ≥3 CVD risk factors but not with having a Pooled Cohort Equations estimate ≥7.5%. CONCLUSIONS The prevalence of CVD risk factors among West African immigrants was particularly high. Being employed and having health insurance were associated with lower CVD risk in women, but only higher social support was associated with lower CVD risk in men.
Collapse
Affiliation(s)
| | - Martha Hill
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - Jerilyn Allen
- Johns Hopkins University School of Nursing, Baltimore, MD
| | | | | | - Charles Agyemang
- Department of Public Health, Academic Medical Centre/University of Amsterdam, The Netherlands
| | | |
Collapse
|
19
|
Abstract
Low birth weight and a rapid weight gain in early childhood may lead to an increased risk for developing cardiovascular disease later in life, such as hypertension and dyslipidaemia. In this study, we examined the associations between size at birth, relative weight gain in infancy and childhood with specific cardiovascular disease risk factors in early adulthood. Adolescents (n=1935) from the Birth to Twenty plus (BT20+) cohort were included in the analysis. The following were treated as exposure variables: weight at birth, and relative conditional weight gain (CW), independent of height, between ages 0-24 months and 24-48 months. Outcomes were serum lipids and body composition variables at age 18 years. After adjusting for sex and other confounders, early life exposures were not associated with adolescent lipid profile. Following adjustment for sex and height (body size), birth weight [β=0.704 (0.40, 1.01)], CW 0-24 [β=1.918 (1.56, 2.28)] and CW24-48 [β=1.485 (1.14, 1.82)] accounted for 48% of the variance in fat mass. However, birth weight [β=0.773 (0.54, 1.01)], CW 0-24 [β=1.523 (1.24, 1.80)] and CW24-48 [β=1.226 (0.97, 1.49)] were also positively predicted and accounted for 71% of the variance in fat mass in adolescence (P<0.05). Our data suggests that birth weight and weight gain during infancy and early childhood independent of linear growth are related to adolescent body composition but not blood lipid profiles in an urban African population.
Collapse
|
20
|
Chantler S, Dickie K, Micklesfield LK, Goedecke JH. Longitudinal Changes in Body Fat and Its Distribution in Relation to Cardiometabolic Risk in Black South African Women. Metab Syndr Relat Disord 2015; 13:381-8. [PMID: 26313235 DOI: 10.1089/met.2015.0021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Ethnic differences in body composition and cardiometabolic risk have been reported in cross-sectional studies. This study aimed to investigate changes in body composition over 5.5 years, and its association with cardiometabolic risk in premenopausal black South African (SA) women. METHODS Changes in body composition and body fat distribution (dual-energy x-ray absorptiometry and computerized tomography), fasting glucose, insulin, and lipid concentrations, were measured in 63 black SA women at baseline (age: 27 ± 8 years), and 5.5 years later. RESULTS Body weight and fat mass (FM) increased by 6.9 ± 9.9 kg and 4.3 ± 6.9 kg, respectively, over the 5.5 years with a relative (%FM) increase in central and decrease in peripheral FM (all P < 0.05). Fasting glucose and lipid concentrations (except HDL-cholesterol) increased over the follow-up period (all P < 0.05). Both baseline and changes in body fat distribution were associated with cardiometabolic risk. Independent of baseline age, FM and insulin sensitivity, baseline trunk:leg was associated with reduced insulin sensitivity at follow-up (Matsuda index; β = -0.41, P = 0.002). Increasing trunk:gynoid ratio was associated with higher plasma insulin levels (β = 0.31, P = 0.023) and reduced insulin sensitivity (Matsuda index; β = -0.52, P < 0.001) at follow-up. CONCLUSIONS Weight gain in free-living black SA women over 5.5 years was associated with a centralization of fat mass, which predicted an increase in cardiometabolic risk.
Collapse
Affiliation(s)
- Sarah Chantler
- 1 Division for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town , Cape Town, South Africa
| | - Kasha Dickie
- 1 Division for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town , Cape Town, South Africa
| | - Lisa K Micklesfield
- 1 Division for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town , Cape Town, South Africa .,2 South African Medical Research Council/University of the Witwatersrand Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of Witwatersrand , Johannesburg, South Africa
| | - Julia H Goedecke
- 1 Division for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town , Cape Town, South Africa .,3 Non-Communicable Disease Research Unit, South African Medical Research Council , Parow, South Africa
| |
Collapse
|
21
|
Ethnic differences in the association between lipid metabolism genes and lipid levels in black and white South African women. Atherosclerosis 2015; 240:311-7. [PMID: 25864161 DOI: 10.1016/j.atherosclerosis.2015.03.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Dyslipidaemia can lead to the development of atherosclerosis and cardiovascular disease (CVD), however its prevalence has been shown to differ between ethnic groups in South Africa (SA). Therefore the aim of this study was to investigate ethnic differences in the association between serum lipid levels and polymorphisms within genes involved in lipid metabolism in black and white SA women. METHODS In a convenient sample of 234 white and 209 black SA women of Xhosa ancestry, body composition (DXA) and fasting serum lipids were measured. Participants were genotyped for the cholesteryl ester transfer protein (CETP, rs708272, B1/B2), lipoprotein lipase (LPL, rs328, S/X), hepatic lipase (LIPC, rs1800588, C/T) and proprotein convertase subtilisin/kexin type 9 (PCSK9, rs28362286, C/X) polymorphisms. RESULTS Compared to white women, black women had lower concentrations of serum total cholesterol (TC, P < 0.001), low density lipoprotein cholesterol (LDL-C, P < 0.001), high density lipoprotein cholesterol (HDL-C, P < 0.001) and triglycerides (TG, P < 0.001). There were significant differences in the genotype and allele frequency distributions between black and white women for the LPL S/X (P < 0.001), PCSK9 C679X (P = 0.002) and LIPC 514C/T (P < 0.001) polymorphisms. In black women only, there were genotype effects on serum lipid levels. Specifically, women with the LPL SX genotype had lower TC and LDL-C and higher HDL-C concentrations than those with the SS genotype and women with the CETP B2 allele had lower LDL-C concentrations than those with the B1B1 genotype. CONCLUSION Polymorphisms within the LPL and CETP genes were associated with a more protective lipid profile in black, but not white SA women. This supports the hypothesis that the more favorable lipid profile of black compared to white SA women is associated with polymorphisms in lipid metabolism genes, specifically the LPL and CETP genes.
Collapse
|
22
|
Lyons JG, Sliwa K, Carrington MJ, Raal F, Pretorius S, Thienemann F, Stewart S. Lower levels of high-density lipoprotein cholesterol in urban Africans presenting with communicable versus non-communicable forms of heart disease: the 'Heart of Soweto' hospital registry study. BMJ Open 2014; 4:e005069. [PMID: 25023131 PMCID: PMC4120399 DOI: 10.1136/bmjopen-2014-005069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To investigate if urban Africans displayed lower levels of atheroprotective high-density lipoprotein cholesterol (HDLC) when presenting with communicable versus non-communicable forms of heart disease (HD) as both acute infection and chronic inflammation reduce HDLC levels. DESIGN Hospital registry of 5328 de novo cases of HD over a 3-year period. SETTING Cardiology Unit, Baragwanath Hospital in Soweto, South Africa. PARTICIPANTS A total of 1199 patients of African descent (59% women; 57.0±13.4 years) had fasting blood lipid levels (total cholesterol (TC), triglyceride, HDLC and low-density lipoprotein cholesterol (LDLC)) documented on admission. Serum inflammatory marker C reactive protein (CRP) was measured in a subset of 367 patients (31% of cases). MAIN OUTCOME MEASURES Lipid profiles were compared according to prespecified classification of non-communicable (eg, hypertensive HD) versus communicable (eg, rheumatic HD) HD. Low HDLC was defined as <1.0 mmol/L for men and <1.2 mmol/L for women, according to applicable South African Clinical Guidelines. RESULTS Overall 694 (58%) of those presenting with HD had low HDLC levels; 344 of 678 (51%) and 350 of 521 (67%) for non-communicable and communicable, respectively (p<0.001). Comparatively, overall prevalence of high TC was 32% and high LDLC was 37%. On an adjusted basis, those with non-communicable HD were more likely to record a low HDLC relative to non-communicable presentations (odds ratio (OR) 1.91, 95% CI 1.42 to 2.57; p<0.001). There was a strong relationship between low HDLC and higher levels of CRP, but only in women. CONCLUSIONS Despite largely favourable lipid profiles, there are clear differences according to aetiology of underlying HD in urban Africans, with younger patients with communicable HD having particularly low levels of HDLC. Appropriate prospective evidence is needed to determine if persistent low levels of HDLC expose patients to increased, long-term risk of atherosclerotic forms of HD. The women-only inverse association between HDLC and CRP warrants further investigation.
Collapse
Affiliation(s)
- Jasmine G Lyons
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Group and IIDMM, University of Cape Town, Cape Town, South Africa
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Melinda J Carrington
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Frederick Raal
- Carbohydrate and Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sandra Pretorius
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Group and IIDMM, University of Cape Town, Cape Town, South Africa
| | - Friedrich Thienemann
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Group and IIDMM, University of Cape Town, Cape Town, South Africa
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town,South Africa
- Infectious Diseases Referral Clinic, GF Jooste Hospital, Manenberg, South Africa
| | - Simon Stewart
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Group and IIDMM, University of Cape Town, Cape Town, South Africa
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
23
|
Raal FJ, Blom DJ, Naidoo S, Bramlage P, Brudi P. Prevalence of dyslipidaemia in statin-treated patients in South Africa: results of the DYSlipidaemia International Study (DYSIS). Cardiovasc J Afr 2014; 24:330-8. [PMID: 24240385 PMCID: PMC3821092 DOI: 10.5830/cvja-2013-071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/18/2013] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular disease (CVD) is the leading cause of mortality worldwide and increased levels of low-density lipoprotein cholesterol (LDL-C) are an important modifiable risk factor. Statins lower LDL-C levels and have been shown to reduce CVD risk. Despite the widespread availability of statins, many patients do not reach the lipid targets recommended by guidelines. We evaluated lipid goal attainment in statin-treated patients in South Africa and analysed variables contributing to poor goal attainment as part of the DYSlipidaemia International Study (DYSIS). METHODS This cross-sectional, observational study enrolled 1 029 consecutive South African patients consulting officebased physicians. Patients were at least 45 years old, had to be treated with a stable dose of statins for at least three months and had been fasting for 12 hours. We evaluated lipid goal attainment and examined variables associated with residual dyslipidaemia [abnormal levels of LDL-C, highdensity lipoprotein cholesterol (HDL-C) and/or triglycerides (TG)]. RESULTS We found that 50.3% of the patients overall did not achieve target LDL-C levels and 73.5% of patients were at very high cardiovascular risk. In addition, 33.7% had low levels of HDL-C, while 45.3% had elevated TG levels despite statin therapy. Asian and mixed-ancestry patients but not black (vs Caucasian thnicity), as well as obese individuals in South Africa were more likely to still have dyslipidaemia involving all three lipid fractions. CONCLUSIONS We observed that many patients in South Africa experienced persistent dyslipidaemia despite statin treatment, supporting the concept that there is a need for more intensive statin therapy or the development of novel treatment strategies. Measures aimed at combating obesity and other lifestyle-related risk factors are also vital for effectively controlling dyslipidaemia and reducing the burden of CVD.
Collapse
Affiliation(s)
- Frederick J Raal
- Carbohydrate and Lipid Metabolism Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | |
Collapse
|
24
|
Rapeport N, Schamroth CL, Blom DJ. Gender and ethnic differences in the control of hyperlipidaemia and other vascular risk factors: insights from the CEntralised Pan-South African survey on tHE Under-treatment of hypercholeSterolaemia (CEPHEUS SA) study. Cardiovasc J Afr 2014; 24:238-42. [PMID: 24217264 PMCID: PMC3767938 DOI: 10.5830/cvja-2013-043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/07/2013] [Indexed: 11/06/2022] Open
Abstract
Aim The aim of the CEntralised Pan-South African survey on tHE Under-treatment of hypercholeSterolaemia (CEPHEUS SA) was to evaluate the current use and efficacy of lipid-lowering drugs (LLDs) in urban patients of different ethnicity with hyperlipidaemia, and to identify possible patient characteristics associated with failure to achieve low-density lipoprotein cholesterol (LDL-C) targets. There is little published data on LDL-C attainment from developing countries. Methods The survey was conducted in 69 study centres in South Africa and recruited consecutive patients who had been prescribed LLDs for at least three months with no dose adjustment for six weeks. All patients provided written consent. One visit was scheduled for data collection, including fasting lipid and glucose, and HbA1c levels. Results Of the 3 001 patients recruited, 2 996 were included in the final analyses; 1 385 subjects were of Caucasian origin (818 male), 510 of African ancestry (168 male), 481 of mixed ancestry (222 male) and 620 of Asian origin (364 male). Only 60.5% of patients on LLDs for at least three months achieved the LDL-C targets recommended by the NCEP ATP III/2004 updated NCEP ATP III guidelines and 52.3% the fourth JETF/South African guidelines. African females were on average younger than females of other ethnic origins, and had the lowest smoking rates but the highest prevalence of obesity, hypertension, the metabolic syndrome and diabetes mellitus (DM), with the worst glycaemic control. Although women were less likely than men to reach goal [OR 0.65 (CI 0.54–0.77), p < 0.001 for NCEP ATP III guidelines and OR 0.76 (CI 0.64–0.91), p < 0.003 for fourth JETF guidelines], women of African ancestry were just as likely not to reach goal as their Caucasian counterparts. Conclusion The results of this survey highlight the sub-optimal lipid control achieved in many South African patients, and profile important gender and ethnic differences. Control of cardiovascular disease risk factors across gender and ethnic groups remains poor.
Collapse
|
25
|
Dickie K, Micklesfield LK, Chantler S, Lambert EV, Goedecke JH. Meeting physical activity guidelines is associated with reduced risk for cardiovascular disease in black South African women; a 5.5-year follow-up study. BMC Public Health 2014; 14:498. [PMID: 24886324 PMCID: PMC4051116 DOI: 10.1186/1471-2458-14-498] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/08/2014] [Indexed: 01/04/2023] Open
Abstract
Background Low levels of physical activity (PA) have been associated with increased risk for cardiovascular disease (CVD) and type 2 diabetes (T2D), but few studies have examined whether meeting international PA guidelines is associated with reduced risk in a black South African (SA) population. The aims of this study were to compare body composition and cardio-metabolic risk factors for CVD and T2D between active and inactive groups (part 1, cross-sectional analysis) and, to determine whether PA level predicts changes in body composition and cardio-metabolic risk factors for CVD and T2D at follow-up after 5.5-years (part 2, longitudinal analysis). Methods Part 1 included a sample of 240 apparently healthy black SA women (26 ± 7 years) who underwent the following measurements at baseline: PA (Global Physical Activity Questionnaire (GPAQ)), body composition and regional fat distribution (dual-energy x-ray absorptiometry and computerised tomography), blood pressure, fasting glucose, insulin and lipid concentrations. For part 2, a sub-sample of women (n = 57) underwent the same measurements after a 5.5-year period. Results At baseline, 61% of women were classified as meeting the guidelines for moderate- to vigorous-intensity physical activity (MVPA) according to GPAQ. Women who were active had significantly lower body weight (p < 0.001), body fat (BMI, fat mass, % body fat, waist circumference, central and appendicular fat mass, all p < 0.001), and measures of insulin resistance (fasting serum insulin and HOMA-IR, both p = 0.01), and higher high-density lipoprotein cholesterol (p = 0.041), compared to the inactive group. At follow-up, all body fat measures increased significantly in both groups and diastolic blood pressure decreased significantly in those who were active at baseline, but did not change in those who were inactive. Conclusions Meeting PA guidelines was associated with decreased risk for CVD and T2D in black SA women, but did not prevent the increase in body fat over time. Interventions promoting physical activity to specifically address obesity in this high-risk group are recommended.
Collapse
Affiliation(s)
| | | | | | | | - Julia H Goedecke
- UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|
26
|
Abstract
The last decade has witnessed major advances in our understanding of the epidemiology and pathophysiology of HIV-related cardiovascular disease in sub-Saharan Africa. In this review, we summarise these and discuss clinically relevant advances in diagnosis and treatment. In the Heart of Soweto Study, 10% of patients with newly diagnosed cardiovascular disease were HIV positive, and the most common HIV-related presentations were cardiomyopathy (38%), pericardial disease (13%) and pulmonary arterial hypertension (8%). HIV-related cardiomyopathy is more common with increased immunosuppression and HIV viraemia. With adequate antiretroviral therapy, the prevalence is low. Contributing factors such as malnutrition and genetic predisposition are under investigation. In other settings, pericardial disease is the most common presentation of HIV-related cardiovascular disease (over 40%), and over 90% of pericardial effusions are due to Mycobacterium tuberculosis (TB) pericarditis. HIV-associated TB pericarditis is associated with a greater prevalence of myopericarditis, a lower rate of progression to constriction, and markedly increased mortality. The role of steroids is currently under investigation in the form of a randomised controlled trial. HIV-associated pulmonary hypertension is significantly more common in sub-Saharan Africa than in developed countries, possibly as a result of interactions between HIV and other infectious agents, with very limited treatment options. It has recently been recognised that patients with HIV are at increased risk of sudden death. Infection with HIV is independently associated with QT prolongation, which is more marked with hepatitis C co-infection and associated with a 4.5-fold higher than expected rate of sudden death. The contribution of coronary disease to the overall burden of HIV-associated cardiovascular disease is still low in sub-Saharan Africa.
Collapse
Affiliation(s)
- Faisal F Syed
- MRCP Division of Cardiovascular Diseases, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
| | | |
Collapse
|