Charles Agyemang

Cardiovascular disease risk prediction in sub-Saharan African populations — Comparative analysis of risk algorithms in the RODAM study

BACKGROUNDnValidated absolute risk equations are currently recommended as the basis of cardiovascular disease (CVD) risk stratification in prevention and control strategies. However, there is no consensus on appropriate equations for sub-Saharan African populations. We assessed agreement between different cardiovascular risk equations among Ghanaian migrant and home populations with no overt CVD.nnnMETHODSnThe 10-year CVD risks were calculated for 3586 participants aged 40-70years in the multi-centre RODAM study among Ghanaians residing in Ghana and Europe using the Framingham laboratory and non-laboratory and Pooled Cohort Equations (PCE) algorithms. Participants were classified as low, moderate or high risk, corresponding to <10%, 10-20% and >20% respectively. Agreement between the risk algorithms was assessed using kappa and correlation coefficients.nnnRESULTSn19.4%, 12.3% and 5.8% were ranked as high 10-year CVD risk by Framingham non-laboratory, Framingham laboratory and PCE, respectively. The median (25th-75th percentiles) estimated 10-year CVD risk was 9.5% (5.4-15.7), 7.3% (3.9-13.2) and 5.0% (2.3-9.7) for Framingham non-laboratory, Framingham laboratory and PCE, respectively. The concordance between PCE and Framingham non-laboratory was better in the home Ghanaian population (kappa=0.42, r=0.738) than the migrant population (kappa=0.24, r=0.732) whereas concordance between PCE and Framingham laboratory was better in migrant Ghanaians (kappa=0.54, r=0.769) than the home population (kappa=0.51, r=0.758).nnnCONCLUSIONnCVD prediction with the same algorithm differs for the migrant and home populations and the interchangeability of Framingham laboratory and non-laboratory algorithms is limited. Validation against CVD outcomes is needed to inform appropriate selection of risk algorithms for use in African ancestry populations.

Ideal cardiovascular health among Ghanaian populations in three European countries and rural and urban Ghana: the RODAM study

Cardiovascular health (CVH) is a construct defined by the American Heart Association (AHA) as part of its 2020 Impact Goal definition. CVH has, until now, not been evaluated in Sub-Saharan African populations. The aim of this study was to investigate differences in the prevalence of ideal CVH and its constituent metrics among Ghanaians living in rural and urban Ghana and Ghanaian migrants living in three European countries. The AHA definition of CVH is based on 7 metrics: smoking, body mass index, diet, physical activity, blood pressure, total cholesterol, and fasting plasma glucose. These were evaluated among 3510 Ghanaian adults (aged 25–70xa0years) residing in rural and urban Ghana and three European cities (Amsterdam, London and Berlin) in the multi-centre RODAM study. Differences between groups were assessed using logistic regression with adjustments for gender, age, and education. Only 0.3% of all participants met all 7 metrics of the AHA’s definition of ideal CVH. Compared to rural Ghana (25.7%), the proportions and adjusted odds ratio (OR) of individuals who had 6–7 CVH metrics in the ideal category were substantially lower in urban Ghana, (7.5%; OR 0.204, 95% CI 0.15–0.29), Amsterdam (4.4%; 0.13, 0.08–0.19), Berlin (2.7%; 0.06, 0.03–0.11), and London (1.7%; 0.04, 0.02–0.09), respectively. The proportion of ideal CVH for the various metrics ranged from 96% for all sites in the smoking metric to below 6% in the diet metric. The proportion of ideal CVH is extremely low in Ghanaians, especially among those living in urban Ghana and Ghanaian migrants in Europe.

Chronic kidney disease burden among African migrants in three European countries and in urban and rural Ghana: the RODAM cross-sectional study

BackgroundnChronic kidney disease (CKD) is a major burden among sub-Saharan African (SSA) populations. However, differences in CKD prevalence between rural and urban settings in Africa, and upon migration to Europe are unknown. We therefore assessed the differences in CKD prevalence among homogenous SSA population (Ghanaians) residing in rural and urban Ghana and in three European cities, and whether conventional risk factors of CKD explained the observed differences. Furthermore, we assessed whether the prevalence of CKD varied among individuals with hypertension and diabetes compared with individuals without these conditions.nnnMethodsnFor this analysis, data from Research on Obesity & Diabetes among African Migrants (RODAM), a multi-centre cross-sectional study, were used. The study included a random sample of 5607 adult Ghanaians living in Europe (1465 Amsterdam, 577 Berlin, 1041 London) and Ghana (1445 urban and 1079 rural) aged 25-70u2009years. CKD status was defined according to severity of kidney disease using the combination of glomerular filtration rate (G1-G5) and albuminuria (A1-A3) levels as defined by the 2012 Kidney Disease: Improving Global Outcomes severity classification. Comparisons among sites were made using logistic regression analysis.nnnResultsnCKD prevalence was lower in Ghanaians living in Europe (10.1%) compared with their compatriots living in Ghana (13.3%) even after adjustment for age, sex and conventional risk factors of CKD [adjusted odds ratio (OR)u2009=u20090.70, 95% confidence interval (CI) 0.56-0.88, Pu2009=u20090.002]. CKD prevalence was markedly lower among Ghanaian migrants with hypertension (adjusted ORu2009=u20090.54, 0.44-0.76, Pu2009=u20090.001) and diabetes (adjusted ORu2009=u20090.37, 0.22-0.62, Pu2009=u20090.001) compared with non-migrant Ghanaians with hypertension and diabetes. No significant differences in CKD prevalence was observed among non-migrant Ghanaians and migrant Ghanaians with no hypertension and diabetes. Among Ghanaian residents in Europe, the odds of CKD were lower in Amsterdam than in Berlin, while among Ghanaian residents in Ghana, the odds of CKD were lower in rural Ghana (adjusted ORu2009=u20090.68, 95% CI 0.53-0.88, Pu2009=u20090.004) than in urban Ghana, but these difference were explained by conventional risk factors.nnnConclusionnOur study shows important differences in CKD prevalence among Ghanaians living in Europe compared with those living in Ghana, independent of conventional risk factors, with marked differences among those with hypertension and diabetes. Further research is needed to identify factors that might explain the observed difference across sites to implement interventions to reduce the high burden of CKD, especially in rural and urban Ghana.

A 20-year trends in renal disease mortality in Ghana: A review of autopsies: Renal disease mortality in Ghana

Data on the changing levels in renal morbidity and mortality are scant globally. We sought to assess trends in renal disease mortality and attributable causes over a 20 year period in Ghana.

Non-communicable diseases in migrants: an expert review

BACKGROUNDnNon-communicable diseases (NCDs) remain a major challenge in the 21st century. High-income countries (HICs) populations are ethnically and culturally diverse due to international migration. Evidence suggests that NCDs rates differ between migrants and the host populations in HICs. This paper presents a review of NCDs burden among migrant groups in HICs in Europe, North America and Australia with a major focus on cardiovascular diseases (CVDs), cancer and diabetes.nnnMETHODSnWe performed a narrative review consisting of scholarly papers published between 1960 until 2018.nnnRESULTSnCVD risk differs by country of origin, country of destination and duration of residence. For example, stroke is more common in sub-Sahara African and South-Asian migrants, but lower in North African and Chinese migrants. Chinese migrants, however, have a higher risk of haemorrhagic stroke despite the lower rate of overall stroke. Coronary heart disease (CHD) is more common in South-Asian migrants, but less common in sub-Saharan and north African migrants although the lower risk of CHD in these population is waning. Diabetes risk is higher in all migrants and migrants seem to develop diabetes at an earlier age than the host populations. Migrants in general have lower rates of overall cancer morbidity and mortality than the host populations in Europe. However, migrants have a higher infectious disease-related cancers than the host populations in Europe. In North America, the picture is more complex. Data from cross-national comparisons indicate that migration-related lifestyle changes associated with the lifestyle of the host population in the country of settlement may influence NCDs risk among migrants in a very significant way.nnnCONCLUSIONnWith exception of diabetes, which is consistently higher in all migrant groups than in the host populations, the burden of NCDs among migrants seems to depend on the migrant group, country of settlement and NCD type. This suggests that more work is needed to disentangle the key migration-related lifestyle changes and contextual factors that may be driving the differential risk of NCDs among migrants in order to assist prevention and clinical management of NCDs in these populations.

Medication non-adherence and blood pressure control among hypertensive migrant and non-migrant populations of sub-Saharan African origin: the RODAM study

Large differences in blood pressure (BP) control rates have been observed between sub-Saharan African migrant populations in Europe compared to their counterparts living in Africa. Our main objective was to investigate whether inter-geographical differences in BP control rates can be explained by differences in medication non-adherence. Additionally, we studied the prevalence of medication non-adherence and associations between medication non-adherence, socio-demographic-related, clinical/treatment-related, lifestyle factors, and experienced stress on the one hand and BP control on the other hand. We used data from the multi-center RODAM (Research on Obesity and Diabetes Among African Migrants) study, from Ghanaians receiving antihypertensive therapy and residing in three European countries versus non-migrants residing in rural and urban Ghana (nu2009=u20091303). Bivariate and multivariate logistic regression analyses stratified by sex were applied. We found inter-geographical differences in BP control rates among Ghanaian males but not among females. Ghanaian males residing in Amsterdam and Berlin had not only the lowest BP control rates but also the lowest rates of medication non-adherence. Inter-geographical differences in BP control rates among males became therefore more pronounced after adjustment for medication adherence. Medication non-adherence was significantly and independently associated with suboptimal BP control in males and females. Other factors associated with suboptimal BP control in females were a higher number of prescribed antihypertensives, higher fasting glucose levels, and pregnancy-induced diabetes. When adjusted for medication non-adherence and socio-demographic-, clinical/treatment-, lifestyle-, and stress-related factors, inter-geographical differences in BP control in males disappeared, except for Berlin. In conclusion, the observed inter-geographical differences in BP control rates in Ghanaian males cannot be explained by differences in medication non-adherence.

Your health is your wealth: faith-based community action on the health of African migrant communities in Amsterdam

The African migrant communities in Europe face many challenges including poor health outcomes. Migrant community leaders can play a crucial role in addressing the health needs of their community members. In this paper, we described Sub-Saharan African migrant community leaders’ action to improve the health of their faith-based community members in Amsterdam, the Netherlands.

Epigenome-wide association study in whole blood on type 2 diabetes among sub-Saharan African individuals: findings from the RODAM study.

BACKGROUNDnType 2 diabetes (T2D) results from a complex interplay between genetics and the environment. Several epigenome-wide association studies (EWAS) have found DNA methylation loci associated with T2D in European populations. However, data from African populations are lacking. We undertook the first EWAS for T2D among sub-Saharan Africans, aiming at identifying ubiquitous and novel DNA methylation loci associated with T2D.nnnMETHODSnThe Illumina 450k DNA-methylation array was used on whole blood samples of 713 Ghanaian participants (256 with T2D, 457 controls) from the cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) study. Differentially methylated positions (DMPs) for T2D and HbA1c were identified through linear regression analysis adjusted for age, sex, estimated cell counts, hybridization batch, array position and body mass index (BMI). We also did a candidate analysis of previously reported EWAS loci for T2D in non-African populations, identified through a systematic literature search.nnnRESULTSnFour DMPs [cg19693031 (TXNIP), cg04816311 (C7orf50), cg00574958 (CPT1A), cg07988171 (TPM4)] were associated with T2D after correction for inflation by possible systematic biases. The most strongly associated DMP-cg19693031, TXNIP (Pu2009=u20092.6E-19) -showed hypomethylation in T2D cases compared with controls. Two out of the four DMPs [cg19693031 (TXNIP), cg04816311 (C7orf50)] remained associated with T2D after adjustment for BMI, and one locus [cg07988171 (TPM4)] that has not been reported previously.nnnCONCLUSIONSnIn this first EWAS for T2D in sub-Saharan Africans, we have identified four DMPs at epigenome-wide level, one of which is novel. These findings provide insight into the epigenetic loci that underlie the burden of T2D in sub-Saharan Africans.

Ethnic differences in hypertension prevalence and contributing determinants – the HELIUS study

Aims There are important ethnic differences in the prevalence of hypertension and hypertension-mediated cardiovascular complications, but there is ongoing debate on the nature of these differences. We assessed the contribution of lifestyle, socio-economic and psychosocial variables to ethnic differences in hypertension prevalence. Methods We used cross-sectional data from the Healthy Life In an Urban Setting (HELIUS) study, including 21,520 participants aged 18–70 years of South-Asian Surinamese (nu2009=u20093032), African Surinamese (nu2009=u20094124), Ghanaian (nu2009=u20092331), Turkish (nu2009=u20093594), Moroccan (nu2009=u20093891) and Dutch (nu2009=u20094548) ethnic origin. Ethnic differences in hypertension prevalence rates were examined using logistic regression models. Results After adjustment for a broad range of variables, significant higher hypertension prevalence compared to the Dutch population remained in Ghanaian men (odds ratio 2.62 (95% confidence interval 2.14–3.22)) and women (4.16 (3.39–5.12)), African Surinamese men (1.62 (1.37–1.92)) and women (2.70 (2.29–3.17)) and South-Asian Surinamese men (1.22 (1.15–1.46)) and women (1.84 (1.53–2.22)). In contrast, Turkish men (0.72 (0.60–0.87)) and Moroccan men (0.50 (0.41–0.61)) and women (0.57 (0.46–0.71)) had a lower hypertension prevalence compared with the Dutch population. The differences in hypertension prevalence were present across different age groups and persisted after stratification for body mass index and waist-to-hip ratio. Conclusion Large ethnic differences in hypertension prevalence exist that are already present in young adulthood. Adjustment for common variables known to be associated with a higher risk of hypertension explained the higher adjusted prevalence rates among Turks and Moroccans, but not in African and South-Asian descent populations who remained to have a higher rate of hypertension compared to the Dutch host population.

Type 2 diabetes mellitus management among Ghanaian migrants resident in three European countries and their compatriots in rural and urban Ghana - The RODAM study

AIMSnTo compare Type 2 Diabetes Mellitus (T2DM) awareness, treatment and control between Ghanaians resident in Ghana and Europe.nnnMETHODSnComparisons were made for the 530 participants of the Research on Obesity and Diabetes among African Migrants (RODAM) study with T2DM (25-70u202fyears) living in Amsterdam, Berlin, London, urban Ghana and rural Ghana. We used logistic regression to assess disparities with adjustment for age, sex and education.nnnRESULTSnT2DM awareness was 51% in rural Ghana. This was lower than levels in Europe ranging from 73% in London (age-sex adjusted odds ratio (OR)u202f=u202f2.7; 95%CIu202f=u202f1.2-6.0) to 79% in Amsterdam (ORu202f=u202f4.7; 95%CIu202f=u202f2.3-9.6). T2DM treatment was also lower in rural Ghana (37%) than in urban Ghana (56%; ORu202f=u202f2.6; 95%CIu202f=u202f1.3-5.3) and European sites ranging from 67% in London (ORu202f=u202f3.4; 95%CIu202f=u202f1.5-7.5) to 73% in Berlin (ORu202f=u202f6.9; 95%CIu202f=u202f2.9-16.4). In contrast, T2DM control in rural Ghana (63%) was comparable to Amsterdam and Berlin, but higher than in London (40%; ORu202f=u202f0.4; 95%CIu202f=u202f0.2-0.9) and urban Ghana (28%; ORu202f=u202f0.3; 95%CIu202f=u202f0.1-0.6).nnnCONCLUSIONSnOur findings suggest that improved detection and treatment of T2DM in rural Ghana, and improved control for people with diagnosed T2DM in London and urban Ghana warrant prioritization. Further work is needed to understand the factors driving the differences.