The association of uric acid and plasminogen activator inhibitor-1 (PAI-1) with cardiovascular function in South African women : the POWIRS-study

Abstract

Motivation: Hypertension is a fast growing health risk, leading to increased incidences of cardiovascular dysfunction and mortality. However, the prevalence of hypertension is higher in some ethnic populations than others. Several South African studies have found that the African population is more susceptible to the development of hypertension, compared to the Caucasian population. Cardiovascular dysfunction is often accompanied by elevated levels of uric acid (UA) and plasminogen activator inhibitor-I (PAI-1) and both are factors associated with the metabolic syndrome. A lack of data regarding the association of UA and PAL1 with cardiovascular dysfunction in a South African context, serves as a motivation for conducting this study. Objective: To determine the association of UA and PAI-1 with cardiovascular dysfunction in African and Caucasian women from South Africa. Methodology: The manuscript presented in Chapter 2 made use of the data obtained in the POWIRS (Profiles of Obese Women with the Insulin Resistance Syndrome) study. A group of 102 African women and 115 Caucasian women, living in the North West Province of South Africa, were recruited according to their body mass indexes. The groups were divided into lean, overweight and obese according to their body mass index. Anthropometric and cardiovascular measurements were taken and determinations were done of their blood lipid profiles, UA. PAI-1, fasting insulin and glucose levels, HOMA-IR (homeostasis model assessment-insulin resistance) and leptin levels. The subject's total dietary protein intake was determined by means of a dietary questionnaire. Comparisons between the groups were done using an independent t-test as well as a multiple analysis of covariance (MANCOVA) whilst adjusting for certain variables. Each ethnic group was divided into UA and PAI-1 tertiles, for comparison between the 1st and 3rd tertiles. Correlation coefficients were determined to show any associations between UA and PAI-1 with cardiovascular variables as well as variables associated with the metabolic syndrome. Forward stepwise multiple regression analyses were performed using UA and PAL1 respectively as dependent variables. The study was approved by the Ethics committee of the North-West University and all the subjects gave informed consent in writing. The reader is referred to the experimental procedure section in Chapter 2 for a more detailed description of the subjects, study design and analytical procedures used in this dissertation. Results and conclusion: Results from the POWIRS-study showed that despite the African women's higher blood pressure, they had significantly lower levels of UA and PAI-I compared to the Caucasian women. Although the Caucasian women had significantly higher circulating levels of UA and PAI-1, they showed no sign of cardiovascular dysfunction. The detrimental effects might, however, become more noticeable with an increase in age. From this study it is concluded that UA and PAL1 is not associated with the increased blood pressure in young African women.