The Cardiometabolic Syndrome in Persons of the African Diaspora: Challenges and Opportunities

Abstract

Unique genetic traits appear to play a role in the increased rates of hypertension (HTN), glucose dysregulation/diabetes (T2DM), and obesity in persons of African descent. Indeed, with increasing rates of westernization/urbanization and concomitant increases in obesity and T2DM, a similar predisposition to the cardiometabolic syndrome and cardiovascular disease (CVD) can be seen in Africans compared with persons of African descent, with CVD reaching epidemic proportions in many areas of Africa. In addition, the complex relationships of metabolic abnormalities that are unique to individuals of African descent have also been demonstrated in Africans. These include: (1) a dissociation of HTN to insulin resistance; (2) relative favorable lipid profile in the setting of increasing rates of CVD; (3) low levels of visceral adiposity in the setting of obesity and insulin resistance; and (4) a dissociation of insulin sensitivity and adiponectin when compared with Caucasians. Although not well understood, these unique relationships suggest that conventional parameters for CVD do not apply to Africans of persons of African descent.

Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis

“…Both these sets of guidelines have been based largely on evidence from studies in European populations and the impact of HIV infection and ART use on metabolic traits, and the utility of early screening and treatment in populations from SSA remains largely unknown. There is evidence to suggest that baseline metabolic profiles 20 and associations between HIV and ART and metabolic risk factors may be different in different ethnic populations, 109 with HIV-infected African-Americans being at higher risk of acute MI in comparison with individuals of European descent 18 , 19 , 109 , 110 . This emphasises the need to examine these factors in SSA, where the burden of HIV infection is the greatest.…”

Ethnic Differences in Resting Heart Rate Variability

“…However, this situation, in which a high score for an ostensibly protective factor is found in an at risk group, is not necessarily uncommon. For example, researchers have noted that despite AAs having higher high-density lipoprotein (HDL) and lower trigylcerides than EAs, AAs still have higher insulin resistance and greater death and disability from cardiovascular disease (69). These paradoxical findings have led some to suggest that a different pattern or different levels of risk factors be adopted for different ethnic groups at least with respect to the metabolic syndrome (69,70).…”

“…These and other findings have been recently summarized by Tehzarhada and colleagues (74), in which they note that differences in vascular activity exist between AAs and EAs and that these differences may contribute to the greater cardiovascular disease prevalence in AAs. Relatedly, blood pressure seems to be a much more important risk factor for AAs than for EAs in the metabolic syndrome profile (69,70). …”

HIV treatment is associated with a twofold higher probability of raised triglycerides: pooled analyses in 21 023 individuals in sub-Saharan Africa

“…Importantly, the relationship between ART and risk factors for CVD in populations from SSA may be more complex because of differences in cardiometabolic risk profiles, HIV strains, efficacy of ART and environmental factors [8][9][10][11][12][13][14][15][16][17][18][19]. It is therefore crucial to assess the association between ART and cardiovascular risk factors in SSA populations -to inform strategies to control the rising burden of CVD in the region.…”