Microvascular and macrovascular complications in type 2 diabetes in a multi-ethnic population based in Amsterdam. The HELIUS study

Objective: To assess ethnic differences in diabetes-related microvascular and macrovascular complication rates in a multi-ethnic population in the Netherlands. Study, design and setting: Data from the HELIUS study comprising of 165 Dutch, 591 South-Asian Surinamese, 494 African Surinamese, 272 Ghanaian, 368 Turkish, and 444 Moroccan participants with diabetes were analyzed. Logistic regression was used to assess ethnic differences in microvascular (nephropathy) and macrovascular (coronary heart disease (CHD), peripheral artery disease (PAD) and stroke) complications, with adjustments for age, sex, education, and the conventional risk factors. Results: In an age-sex adjusted model, ethnic minorities had higher odds of nephropathy than Dutch except for Ghanaians and African Surinamese. The difference remained statistically significant in South-Asian Surinamese (odds ratio: 2.29; 95% CI, 1.09–4.80), but not in the Turkish (1.01; 0.43–2.38) and Moroccan (1.56; 0.68–3.53) participants. The odds of CHD was higher in all ethnic minorities than in Dutch, with the odds ratios ranging from 2.73 (1.09–6.84) in Ghanaians to 6.65 (2.77–15.90) in Turkish in the fully-adjusted model. There were no ethnic differences in the odds of PAD and stroke. Conclusions: The findings suggest ethnic inequalities in macrovascular and microvascular complications in diabetes, with nephropathy and CHD being the most common complications affecting ethnic minorities

Association between albuminuria and retinal microvascular dysfunction in type 2 diabetes with and without hypertension

Background: Studies assessing the concordance of albuminuria and retinal microvascular dysfunction (RMD) in type 2 diabetes (T2D) have yielded inconsistent results. Similar to ethnicity, hypertension may be a potential explanatory variable. We compared the association between albuminuria and RMD in West Africans with T2D with and without hypertension. Materials and methods: This was a cross-sectional study among 177 systematically sampled Ghanaians with T2D aged ≥ 35 years. Albuminuria was based on urinary albumin-creatinine ratio≥30 mg/g. Retinal images were analyzed and graded according to the Early Treatment Diabetic Retinopathy Study criteria. Logistic regression was used to examine the associations of albuminuria and RMD with adjustments for age, sex, socioeconomic status, diabetes duration, HbA1c, smoking, systolic blood pressure (BP), BMI, and total cholesterol. Results: RMD was more prevalent in individuals with albuminuria than in those without albuminuria (41.7% vs. 24.0%, p = 0.026). In the fully adjusted model, albuminuria remained significantly associated with RMD (odds ratio 2.41[95% CI:1.00–5.80], p = 0.049); the association between albuminuria and RMD was more pronounced in individuals with hypertension (3.10 [1.01–9.50], 0.048) than without hypertension (1.70[0.33–8.77],0.523). In analyses stratified by BP control, albuminuria was significantly associated with RMD in individuals with suboptimal BP (2.76[1.07–7.14], 0.037) but not in individuals with optimal BP (0.24[0.00–17.04],0.512) Conclusion: Our study shows positive associations between albuminuria and RMD among West Africans with T2D, with the strength of association, accentuated in individuals with hypertension/suboptimal BP. Future studies could further characterize the role of hypertension in the associations between albuminuria and RMD

Ethnic disparities in the association between low-grade inflammation biomarkers and chronic kidney disease: The HELIUS Cohort Study

Aims: Ethnic differences exist in the prevalence and progression of chronic kidney disease (CKD). However, underlying mechanisms remain unclear. It has been proposed that chronic low-grade inflammation plays an important role in CKD pathogenesis. In the current analysis, we study the association between systemic inflammatory biomarkers and CKD prevalence in different ethnic groups. Methods: We examined cross-sectional associations between biomarkers of low-grade inflammation, including serum high-sensitive (hs)-CRP, fibrinogen, and D-dimer, and CKD prevalence in different ethnic groups residing in Amsterdam, the Netherlands. We included 5740 participants (similar-sized Dutch, African Surinamese, South-Asian Surinamese, Ghanaian, Turkish and Moroccan populations) aged 18 to 70 years of the Healthy Life in an Urban Setting study (HELIUS) cohort. Results: In the fully adjusted models, adjusted for ethnicity-specific cut-off values, elevated fibrinogen [odds ratio 2.50 (95 % confidence interval 1.10–5.78)] and D-dimer [2.99 (1.28–7.00)] were significantly associated with CKD in Dutch. In South-Asian Surinamese, a significant association with elevated D-dimer [2.66 (1.32–5.37)] was found. Conclusions: Our study shows that there are both differences in biomarker levels and the association with CKD across ethnic groups. Future research to identify potential drivers of the differential associations and susceptibility of CKD among ethnic groups to reduce the CKD burden is necessary

Ethnic disparities in the association between low-grade inflammation biomarkers and chronic kidney disease: The HELIUS Cohort Study

Aims: Ethnic differences exist in the prevalence and progression of chronic kidney disease (CKD). However, underlying mechanisms remain unclear. It has been proposed that chronic low-grade inflammation plays an important role in CKD pathogenesis. In the current analysis, we study the association between systemic inflammatory biomarkers and CKD prevalence in different ethnic groups. Methods: We examined cross-sectional associations between biomarkers of low-grade inflammation, including serum high-sensitive (hs)-CRP, fibrinogen, and D-dimer, and CKD prevalence in different ethnic groups residing in Amsterdam, the Netherlands. We included 5740 participants (similar-sized Dutch, African Surinamese, South-Asian Surinamese, Ghanaian, Turkish and Moroccan populations) aged 18 to 70 years of the Healthy Life in an Urban Setting study (HELIUS) cohort. Results: In the fully adjusted models, adjusted for ethnicity-specific cut-off values, elevated fibrinogen [odds ratio 2.50 (95 % confidence interval 1.10–5.78)] and D-dimer [2.99 (1.28–7.00)] were significantly associated with CKD in Dutch. In South-Asian Surinamese, a significant association with elevated D-dimer [2.66 (1.32–5.37)] was found. Conclusions: Our study shows that there are both differences in biomarker levels and the association with CKD across ethnic groups. Future research to identify potential drivers of the differential associations and susceptibility of CKD among ethnic groups to reduce the CKD burden is necessary

Associations between macrovascular and renal microvascular dysfunction in type 2 diabetes and non-diabetes: the HELIUS study

Background: Although the associations between measures of macrovascular and microvascular dysfunctions are well characterized in diabetes, there is limited data on these associations in individuals without diabetes. We compared the associations between macrovascular dysfunction and renal microvascular dysfunction in individuals with type 2 diabetes (T2D) and without diabetes. Methods: Cross-sectional analyses of baseline data from the multiethnic Healthy Life in an Urban Setting (HELIUS) study (Amsterdam, the Netherlands), including 986 participants with T2D and 7680 participants without diabetes were done. Logistic regression analyses were used to examine the associations between macrovascular dysfunction [aortic stiffness, coronary artery disease (CAD), peripheral artery disease (PAD), and stroke] and renal microvascular dysfunction [albuminuria] with adjustments for age, sex, ethnicity, waist-to-hip ratio, systolic blood pressure, LDL-cholesterol, and smoking (and HbA1c and diabetes duration for the T2D group). Results: In the fully adjusted models, aortic stiffness was associated with albuminuria in individuals with T2D [OR 2.55; 95% CI,1.30–4.98], but not without diabetes [0.96; 0.63–1.45]; stroke was associated with albuminuria in T2D [2.40;1.10–5.25], but not in non-diabetes [1.39;0.83–2.33]. In age-sex adjusted models, CAD was associated with albuminuria in T2D [1.65;1.09–2.50] and in non-diabetes [1.56;1.13–2.15]; the associations were no longer significant in the fully adjusted model. There were no associations between PAD and albuminuria in T2D and non-diabetes. Conclusions: Our study shows important differences in the associations between measures of macrovascular and renal microvascular dysfunction in T2D and non-diabetes. These findings provide opportunities for future research aimed at prevention and treatment strategies for individuals with vascular dysfunction

Inflammation and its associations with aortic stiffness, coronary artery disease and peripheral artery disease in different ethnic groups: The HELIUS Study

Background: evidence shows important ethnic differences in vascular dysfunction rates; however, the mechanisms driving these differences remain unclear. One potential factor is the ethnic differences in the role of inflammation in vascular injury. We tested the hypothesis that low-grade inflammation is unequally associated with vascular dysfunction in different ethnic groups. Methods: we included 5698 participants (similar-sized Dutch, African Surinamese, South-Asian Surinamese, Ghanaians, Turkish, and Moroccans) of the HELIUS study (the Netherlands) conducted between 2011 and 2015. Logistic regression was used to examine the associations of Z-score inflammatory biomarker concentration (high sensitivity C-reactive protein [hs-CRP], fibrinogen, and D-dimer) with vascular dysfunction (aortic stiffness, coronary artery disease [CAD], and peripheral artery disease [PAD]), with adjustments for age, sex, smoking (pack-years), BMI, hypertension, HbA1c, total cholesterol, and statin use Findings: in the fully adjusted models, higher Z-score hs-CRP was positively associated with CAD in Dutch [OR 1·63, (95% CI 1·21–2·18)] and PAD in South Asians [1·25(1·03–1·53)], respectively. Higher Z-score fibrinogen was positively associated with CAD in African Surinamese [1·28(1·03–1·59)] while higher Z-score D-dimer was positively associated with PAD in Moroccans [1·39(1·01–1·93)]. Higher Z-score hs-CRP [0·71(0·54–0·94)] and fibrinogen [0·75(0·58–0·97)] concentrations were negatively associated with PAD in African Surinamese. Interpretation: our study shows that inflammatory biomarkers are unequally associated with vascular dysfunction in different ethnic groups. These observations provide opportunities for future studies aimed at assessing the predictive roles of inflammation on vascular disease in different ethnic groups

Inflammation and its associations with aortic stiffness, coronary artery disease and peripheral artery disease in different ethnic groups: The HELIUS Study

Background: evidence shows important ethnic differences in vascular dysfunction rates; however, the mechanisms driving these differences remain unclear. One potential factor is the ethnic differences in the role of inflammation in vascular injury. We tested the hypothesis that low-grade inflammation is unequally associated with vascular dysfunction in different ethnic groups. Methods: we included 5698 participants (similar-sized Dutch, African Surinamese, South-Asian Surinamese, Ghanaians, Turkish, and Moroccans) of the HELIUS study (the Netherlands) conducted between 2011 and 2015. Logistic regression was used to examine the associations of Z-score inflammatory biomarker concentration (high sensitivity C-reactive protein [hs-CRP], fibrinogen, and D-dimer) with vascular dysfunction (aortic stiffness, coronary artery disease [CAD], and peripheral artery disease [PAD]), with adjustments for age, sex, smoking (pack-years), BMI, hypertension, HbA1c, total cholesterol, and statin use Findings: in the fully adjusted models, higher Z-score hs-CRP was positively associated with CAD in Dutch [OR 1·63, (95% CI 1·21–2·18)] and PAD in South Asians [1·25(1·03–1·53)], respectively. Higher Z-score fibrinogen was positively associated with CAD in African Surinamese [1·28(1·03–1·59)] while higher Z-score D-dimer was positively associated with PAD in Moroccans [1·39(1·01–1·93)]. Higher Z-score hs-CRP [0·71(0·54–0·94)] and fibrinogen [0·75(0·58–0·97)] concentrations were negatively associated with PAD in African Surinamese. Interpretation: our study shows that inflammatory biomarkers are unequally associated with vascular dysfunction in different ethnic groups. These observations provide opportunities for future studies aimed at assessing the predictive roles of inflammation on vascular disease in different ethnic groups

Associations of Serum Uric Acid Levels with Macrovascular and Renal Microvascular Dysfunction among Individuals from Sub-Saharan Africa

Importance: Serum uric acid (SUA) level is associated with vascular dysfunction in Eurasian populations, but little is known about this association in individuals from sub-Saharan Africa, who have a high prevalence of both relatively high SUA levels and vascular dysfunction. Objectives: To assess the associations of SUA levels with macrovascular and kidney microvascular dysfunction in individuals of sub-Saharan African ancestry and evaluate potential factors that could mediate these associations. Design, Setting, and Participants: Cross-sectional analyses of baseline data from the multicenter Research on Obesity and Diabetes Among African Migrants study, conducted from 2012 to 2015, were performed from January to March 2021. The population included Ghanaian individuals living in Ghana and Europe. Exposure: Abnormal SUA levels. Main Outcomes and Measures: Logistic regression was used to examine the associations of SUA level quartiles with microvascular (albuminuria) and macrovascular (peripheral artery disease and coronary artery disease) dysfunction, with adjustments for age, sex, estimated glomerular filtration rate, site of residence, socioeconomic status, alcohol, smoking, diabetes, hypertension, waist-hip ratio, and total cholesterol level. Mediation analysis was performed to assess whether the association was via elevated blood pressure, hemoglobin A1c, and high-sensitivity C-reactive protein levels or via weight-hip ratio. The research questions were formulated after data collection. Results: A total of 4919 Ghanaian individuals (3047 [61.9%] women) aged 25-75 years (mean [SD], 46.26 [11.08] years) were included. There was a significant positive association between SUA quartiles and albuminuria, but not coronary artery disease or peripheral artery disease, after adjustment for covariates. After full adjustment, individuals in the fourth SUA quartile had higher odds of albuminuria (adjusted odds ratio [aOR], 1.54; 95% CI, 1.07-2.21), but not peripheral artery disease (aOR, 1.35; 95% CI, 0.87-2.08) or coronary artery disease (aOR, 1.09; 95% CI, 0.77-1.55), compared with individuals in the first quartile. After full adjustment, systolic and diastolic blood pressure significantly mediated the association between SUA concentrations and albuminuria, accounting for 19.4% of the total association for systolic and 17.2% for diastolic blood pressure; hemoglobin A1c, high-sensitivity C-reactive protein, and waist-hip ratio did not mediate this association. Conclusions and Relevance: In this cross-sectional study among a sub-Saharan African population, elevated SUA levels were significantly associated with kidney microvascular dysfunction and mediated partly through elevated blood pressure. These findings suggest that individuals from sub-Saharan Africa with elevated SUA levels may benefit from periodic screening for kidney microvascular dysfunction to aid early detection or treatment

Macrovascular and renal microvascular complications in West Africans with intermediate hyperglycemia living in West Africa and Europe: The RODAM study

Background: Metabolic conditions, including intermediate hyperglycemia (IH), affect migrants to a greater extent than the populations of origin. Evidence suggests that IH increases the risk of vascular complications, but it is unclear whether the differences in IH between the non-migrant and migrant populations translate to differences in vascular complications between the two populations. We compared the prevalence of macrovascular and renal microvascular complications among West Africans with IH living in West Africa and their migrant compatriots in Europe. Methods: Data from the multicenter Research on Obesity and Diabetes among African Migrants(RODAM) study were analyzed. Ghanaians with IH(524 non-migrant and 1439 migrants) were included. Logistic regression analyses were used to determine the associations between migrant status and macrovascular [coronary artery disease(CAD) and peripheral artery disease(PAD)] and renal microvascular[nephropathy] complications with adjustment for age, sex, socioeconomic status, smoking, systolic blood pressure, BMI, total cholesterol, HbA1c, C-reactive protein, and serum uric acid. Findings: The prevalence of microvascular/macrovascular complications was higher in non-migrants than in migrants(nephropathy 15.3vs.9.7%; PAD 3.1%vs.1.3%; and CAD 15.8% vs. 5.0%). The differences persisted in the fully adjusted model: nephropathy [odds ratio, 2.12; 95% CI(1.46–3.08); PAD, 4.44(1.87–10.51); CAD 2.35(1.64–3.37)]. Non-migrant females had higher odds of nephropathy[2.14(1.34–3.43)], PAD[7.47(2.38–23.40)] and CAD [2.10(1.34–3.27)] compared to migrant females. Non-migrant males had higher odds of nephropathy[2.54(1.30–4.97)] and CAD[2.85(1.48–5.50)], but not PAD[1.81(0.32–10.29)],than their migrant peers. Interpretation: Macrovascular and renal microvascular complications were more prevalent in non-migrants than in migrant West Africans with IH. Further studies are needed to identify factors that increase the risk to aid preventive/treatment strategies

Higher prevalence of peripheral arterial disease in Ghana compared to Ghanaian migrants in Europe : The RODAM study

Background: Evidence suggests that the burden of peripheral artery disease (PAD) is rising more rapidly than other forms of cardiovascular diseases in sub-Saharan Africa, but the extent to which they differ between rural and urban settings in Africa and upon migration to Europe is unknown. We assessed the burden of PAD among Ghanaians living in rural- and urban-Ghana and Ghanaian migrants living in three European countries. Methods: Cross-sectional analyses of baseline data from the multicenter Research on Obesity and Diabetes among African Migrants (RODAM) study were done. Data from 5516 participants living in Europe (1487 Amsterdam, 546 Berlin, 1047 London) and Ghana [1419 urban and 1017 rural] aged 25–70 years were included. PAD was defined as ankle brachial index≤0.90. Comparisons among sites were made using logistic regression analysis. Results: The age-standardized prevalence of PAD was higher in Ghanaians living in rural [7.52%, 95% CI = 5.87–9.51] and urban [8.93%, 7.44–10.64] Ghana than for their compatriots living in Europe [5.70%, 4.35–7.35 for London; 3.94%, 2.96–5.14 for Amsterdam; and 0.44%, 0.05–1.58 for Berlin]. The differences persisted even after adjustment for age, sex, education and the conventional cardiovascular risk factors [adjusted odds ratio = 3.16, 95% CI = 2.16–4.61, p < .001 for rural-Ghana; and 2.93, 1.87–4.58, p < .00 for urban-Ghana, compared with Ghanaian migrants in Europe]. Conclusions: Our study shows that Ghanaians living in Ghana have higher prevalence of PAD than their migrant compatriots. Further work is needed to identify potential factors driving the high prevalence of PAD among non-migrant Ghanaians to assist interventions aimed at reducing PAD burden