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Cardiovascular disease (CVD) remains a global health challenge and contributes substantially to mortality burden in sub-Saharan Africa (SSA) in particular. Several factors, including particular blood group types in the ABO system, have been associated with CVD risk. However, the direction of the association of ABO blood groups with CVD remains controversial. This review looked at the studies that investigated the association of ABO blood groups and CVD and its risk in SSA and people of African ancestry. The review included all observational studies that investigated ABO blood groups and their association with CVD and CVD risk in Africans and people of African descent and were published in English between 1960 and 2023. The data were extracted from Pubmed, Google Scholar, ScienceDirect, Web of Science, Scopus, African Wide and Medline. A total of 24 publications were reviewed following the inclusion criteria. The protocol for this systematic review was registered with PROSPERO (ID#: CRD42023495721). A total of 24 studies were included in the review with most of them being cross-sectional in design. The mean age of participants was 44 years with an age range of 1-89 years. The most common blood group in SSA was blood group O. The review showed that 11 out of the 24 studies indicated non-O groups association with CVD and CVD risk and 4 studies indicated blood group O association with CVD risk. The most common CVD risk markers studied were body mass index (BMI) and blood pressure (BP). The CVDs investigated were ischaemic disease, intracranial aneurysm, peripheral artery disease and coronary artery disease. There is no conclusive evidence showing a particular blood group, in the ABO system, being cardioprotective or more susceptible to CVD risk. The varying ABO associations with CVD risk among Africans and African ancestry underscore the importance of targeted and localised interventions aimed at curbing CVD against the backdrop of ABO profiling.

Atherosclerosis precedes the onset of clinical manifestations of cardiovascular diseases (CVDs). We used carotid intima-media thickness (cIMT) to investigate genetic susceptibility to atherosclerosis in 7894 unrelated adults (3963 women, 3931 men; 40 to 60 years) resident in four sub-Saharan African countries. cIMT was measured by ultrasound and genotyping was performed on the H3Africa SNP Array. Two new African-specific genome-wide significant loci for mean-max cIMT, SIRPA (p = 4.7E-08), and FBXL17 (p = 2.5E-08), were identified. Sex-stratified analysis revealed associations with one male-specific locus, SNX29 (p = 6.3E-09), and two female-specific loci, LARP6 (p = 2.4E-09) and PROK1 (p = 1.0E-08). We replicate previous cIMT associations with different lead SNPs in linkage disequilibrium with SNPs primarily identified in European populations. Our study find significant enrichment for genes involved in oestrogen response from female-specific signals. The genes identified show biological relevance to atherosclerosis and/or CVDs, sex-differences and transferability of signals from non-African studies. Genetic studies of disease-relevant traits have mostly been performed on European populations. Here, the authors perform a genome-wide association study for carotid intima-media thickness, in sub-Saharan African samples, finding population-specific and sex-specific loci.

Introduction Insulin resistance (IR) is linked to several metabolic diseases including type 2 diabetes mellitus (T2DM), metabolic syndrome, and metabolic dysfunction-associated fatty liver disease (MAFD). The factors that contribute to IR in rural African populations remain largely unknown. Understanding the determinants of IR will contribute to the management of several non-communicable diseases (NCDs). Methods A cross-sectional study was conducted in two rural districts in northern Ghana involving male and female participants, aged 40 to 60 years, who were recruited into the study between the years 2015 and 2016. Sociodemographic, lifestyle, anthropometric, ultrasound, blood lipid profile, blood glucose and insulin, urine creatinine and urine protein data were collected. Insulin resistance was determined using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) formula. Multivariable linear regression analyses were performed between log-transformed IR and several variables. All association analyses were considered significant at p  < 0.05. Results The median (log-transformed) IR among women (0.54) was significantly higher than that among men (0.43) ( p  < 0.001). The prevalence of IR was 7.6% in the study population with more women having IR (9.9%) than men (4.5%) ( p  = 0.007). Drivers of IR among women were unmarried status (β = 1.19, p  = 0.037), smoking (β = 8.33, P  = 0.001) and triglyceride (TG) (β = 2.09, p  = 0.016) while that among men were body mass index (BMI) (β = 0.47, p  = 0.013), right carotid intima median thickness (CIMT right ) (β = 5.08, p  = 0.033), visceral adipose tissue (VAT) (β = 0.59, p  = 0.031) and TG (β = 5.58, p  < 0.001). Among the total population, vendor meal consumption (β = 0.41, p  = 0.001), CIMT right (β = 3.54, p  = 0.028), low-density lipoprotein cholesterol (LDL-C) (β = 1.08, p  = 0.012), and TG (β = 2.87, p  < 0.001) were linked to IR. Conclusions Lifestyle, adiposity, CIMT right and lipid markers contribute to driving IR levels and that these factors are gender-specific in this northern rural Ghanaian population.

The analysis of the effects of autozygosity, measured as the change of the mean value of a trait among offspring of genetic relatives, reveals the existence of directional dominance or overdominance. In this study we detect evidence of the effect of autozygosity in 4 out of 13 cardiometabolic disease-associated traits using data from more than 10,000 sub-Saharan African individuals recruited from Ghana, Burkina Faso, Kenya and South Africa. The effect of autozygosity on these phenotypes is found to be sex-related, with inbreeding having a significant decreasing effect in men but a significant increasing effect in women for several traits (body mass index, subcutaneous adipose tissue, low-density lipoproteins and total cholesterol levels). Overall, the effect of inbreeding depression is more intense in men. Differential effects of inbreeding depression are also observed between study sites with different night-light intensity used as proxy for urban development. These results suggest a directional dominant genetic component mediated by environmental interactions and sex-specific differences in genetic architecture for these traits in the Africa Wits-INDEPTH partnership for Genomic Studies (AWI-Gen) cohort. The prevalence of cardiometabolic diseases (CMDs) is increasing rapidly across Africa. Here, the authors investigate autozygosity in CMD-associated traits in over 10,000 sub-Saharan African individuals, showing these traits are influenced by sex-specific inbreeding depression and environmental interactions.

Few studies have compared the utility of serum levels of lipid fractions in cardiovascular disease (CVD) risk assessment in sub-Saharan Africa (SSA). The current study interrogated this question among men and women aged 40–60 years in rural northern Ghana. This was a cross-sectional study in which data was collected on socio-demography, behaviour, health history, anthropometry and lipid levels. Adjusted multivariable logistic regression models were used to assess the association of various lipid metrics with CVD. All tests were considered statistically significant at P<0.05. Data were available for 1839 participants. The prevalence of self-reported CVD was 1.6% (n = 29). Non-HDL-C (median (interquartile range): 2.4 (1.9–3.0) vs 2.0 (1.6–2.5) mmol/L; P = 0.009), LDL-C/HDL-C (1.8 (1.4–2.4) vs 1.5 (1.1–2.6); P = 0.019) and TC/HDL-C (3.3 (2.9–3.9) vs 2.9 (2.4–3.5); P = 0.003) were all significantly higher in participants with self-reported CVD compared to those without. However, after adjusting for socioeconomic status (SES) and meals from vendors in a logistic regression model, only non-HDL-C (odds ratio [95% CIs]): (1.58 [1.05, 2.39]), P = 0.029 and LDL-C/HDL-C levels (odds ratio [95% CIs]): (1.26 [1.00, 1.59]), P = 0.045 remained significantly associated with self-reported CVD. While our findings suggest non-HDL-C and LDL-C/HDL-C measures may be appropriate biomarkers for assessing CVD risk in this population, further studies using established clinical endpoints are required to validate these findings in sub-Saharan Africans.

Few studies have compared the utility of serum levels of lipid fractions in cardiovascular disease (CVD) risk assessment in sub-Saharan Africa (SSA). The current study interrogated this question among men and women aged 40–60 years in rural northern Ghana. This was a cross-sectional study in which data was collected on socio-demography, behaviour, health history, anthropometry and lipid levels. Adjusted multivariable logistic regression models were used to assess the association of various lipid metrics with CVD. All tests were considered statistically significant at P<0.05. Data were available for 1839 participants. The prevalence of self-reported CVD was 1.6% (n = 29). Non-HDL-C (median (interquartile range): 2.4 (1.9–3.0) vs 2.0 (1.6–2.5) mmol/L; P = 0.009), LDL-C/HDL-C (1.8 (1.4–2.4) vs 1.5 (1.1–2.6); P = 0.019) and TC/HDL-C (3.3 (2.9–3.9) vs 2.9 (2.4–3.5); P = 0.003) were all significantly higher in participants with self-reported CVD compared to those without. However, after adjusting for socioeconomic status (SES) and meals from vendors in a logistic regression model, only non-HDL-C (odds ratio [95% CIs]): (1.58 [1.05, 2.39]), P = 0.029 and LDL-C/HDL-C levels (odds ratio [95% CIs]): (1.26 [1.00, 1.59]), P = 0.045 remained significantly associated with self-reported CVD. While our findings suggest non-HDL-C and LDL-C/HDL-C measures may be appropriate biomarkers for assessing CVD risk in this population, further studies using established clinical endpoints are required to validate these findings in sub-Saharan Africans.

Genetic associations for lipid traits have identified hundreds of variants with clear differences across European, Asian and African studies. Based on a sub-Saharan-African GWAS for lipid traits in the population cross-sectional AWI-Gen cohort ( N  = 10,603) we report a novel LDL-C association in the GATB region ( P -value=1.56 × 10 −8 ). Meta-analysis with four other African cohorts ( N  = 23,718) provides supporting evidence for the LDL-C association with the GATB/FHIP1A region and identifies a novel triglyceride association signal close to the FHIT gene ( P -value =2.66 × 10 −8 ). Our data enable fine-mapping of several well-known lipid-trait loci including LDLR, PMFBP1 and LPA . The transferability of signals detected in two large global studies (GLGC and PAGE) consistently improves with an increase in the size of the African replication cohort. Polygenic risk score analysis shows increased predictive accuracy for LDL-C levels with the narrowing of genetic distance between the discovery dataset and our cohort. Novel discovery is enhanced with the inclusion of African data. Genetic associations and polygenic scores for lipid traits have low transferability to African individuals. Here, the authors perform a large sub-Sarahan African lipid GWAS and find that larger datasets and better global representation in discovery GWAS help to bridge this gap.

Background Malaria and typhoid fever constitute a significant public health burden in developing countries, often traced to a common predisposing factor such as poverty and poor water, sanitation, and hygiene (WASH) practices. This study investigated the prevalence of malaria, typhoid fever, their co-infection and associated factors among febrile patients in the Kassena Nankana Municipal and Nabdam Districts of the Upper East Region, Ghana. Methods A health facility-based cross-sectional study was conducted in seven selected health facilities in the two districts in the Upper East Region of Ghana during peak rainy seasons (July to November) in 2023 and 2024. After informed consent documentation, a total of 332 febrile patients were recruited. Sociodemographic and clinical information of participants was obtained using a structured questionnaire. A finger prick capillary blood sample was collected for malaria antigen rapid test and typhoid fever IgM antibody serology. Results The prevalence of febrile patients with either malaria, typhoid fever or both was 60.0%. The seroprevalence of malaria and typhoid fever was 37.7% and 36.7%, respectively, with a 14.7% co-infection rate. The Nabdam district was associated with increased odds of malaria (adjusted odds ratio (aOR) = 3.87; 95%CI: [1.71–8.76]; p  < 0.01), while a tertiary education background was significantly associated with increased odds of typhoid fever (aOR = 5.33; 95%CI: [1.20–23.72]; p  = 0.03). The use of a tap water source was associated with reduced odds of typhoid fever (aOR = 0.36; 95%CI: [0.15–0.87]; p  = 0.02) and malaria-typhoid fever co-infection (aOR = 0.07; 95%CI: [0.01–0.60]; p  = 0.02). Febrile patients presenting with vomiting were a predictor of malaria (aOR = 2.45; 95%CI: [1.36–4.40]; p  < 0.01). Conclusion Our study found high prevalence of malaria (37.7%), typhoid fever (36.7%), and their co-infection (14.7%) among febrile patients in the Upper East Region of Ghana. These rates exceed national averages and highlight persistent regional disparities, underscoring the need for integrated diagnostic and treatment strategies for febrile illnesses in the region. Our study also shows that malaria risk was higher in Nabdam district, tertiary education was associated with increased typhoid fever risk, and tap water use reduced odds of typhoid fever and malaria-typhoid co-infection, highlighting the need for targeted interventions addressing these factors. Clinical trial number: Not applicable.

Most hypertension-related genome-wide association studies (GWASs) focus on non-African populations, despite hypertension (a major risk factor for cardiovascular disease) being highly prevalent in Africa. The AWI-Gen study GWAS meta-analysis for blood pressure (BP)-related traits (systolic and diastolic BP, pulse pressure, mean-arterial pressure and hypertension) from three sub-Saharan African geographic regions (N = 10,775), identifies two novel genome-wide significant signals (p < 5E-08): systolic BP near P2RY1 (rs77846204; intergenic variant, p = 4.95E-08) and pulse pressure near LINC01256 (rs80141533; intergenic variant, p = 1.76E-08). No genome-wide signals are detected for the AWI-Gen GWAS meta-analysis with previous African-ancestry GWASs (UK Biobank (African), Uganda Genome Resource). Suggestive signals (p < 5E-06) are observed for all traits, with 29 SNPs associating with more than one trait and several replicating known associations. Polygenic risk scores (PRSs) developed from studies on different ancestries have limited transferability, with multi-ancestry PRS providing better prediction. This study provides insights into the genetics of BP variation in African populations. Hypertension is a major risk factor for cardiovascular disease prevalent in Africa. Here the authors report a genome-wide study providing insights into the genetics and physiology of blood pressure variation in African populations.

Dyslipidaemia is a primary risk factor for cardiometabolic disease, causing over 17 million deaths globally in 2015. However, the burden of dyslipidaemia and factors associated with lipid levels remain unknown in many rural African populations. Therefore, this study evaluated the association of socio-demographic, anthropometric and behavioural factors with lipid levels in rural Ghana. The prevalence of hypercholesterolaemia, hypertriglyceridaemia and elevated LDL-C in the total population of 1839 (846 men and 993 women) was 4.02%, 2.12%, and 5.55% respectively and did not differ between genders. The prevalence of low HDL-C levels was 60.30% and differed (p = 0.005) between men (56.86%) and women (63.24%). Subcutaneous abdominal fat was associated with TC (β = 0.067, p = 0.015) and TG (β = 0.137, p<0.001) among women and LDL-C (β = 0.139, p = 0.006) and TC (β = 0.071, p = 0.048) among men. Body mass index was associated with TC (β = 0.010, p = 0.043) among men while waist circumference was associated with LDL-C (β = 0.116, p<0.001) and TG (β = 0.094, p<0.001) among women. Hip circumference was negatively associated (β = -0.053, p = 0.043) while visceral fat was positively associated with TG (β = 0.033, p = 0.022) among women. Socioeconomic status, education, being unmarried and employment were associated with HDL-C (β = 0.081, p = 0.004), LDL-C (β = 0.095, p = 0.004) and TG (β = 0.095, p = 0.001) all among women, and TC (β = 0.070, p = 0.010) among men, respectively. Nankana women had lower TC (β = -0.069, p = 0.001), and men lower TG levels (β = -0.084, p = 0.008) than the other ethnic groups. Tobacco smoking (β = 0.066, p = 0.024) and alcohol intake (β = 0.084, p = 0.001) were associated with HDL-C levels among men and women respectively. Further studies are required to investigate whether high prevalence of low HDL-C levels in this population presents with any adverse cardiovascular disease outcomes. Associations of education, employment and adiposity with lipid levels suggest that future societal advances and increases in the prevalence of obesity may lead to associated adverse health consequences. Monitoring and interventions are required to limit these effects.