The association of von Willebrand factor and its cleaving protease (ADAMTS13) with health behaviours in young black and white adults: the African-PREDICT study
Navise, Nonkululeko Hellen
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Motivation: Stroke is the second leading cause of death worldwide. In South Africa, the stroke incidence and mortality rate increased significantly in the last 30 years. Elevated plasma levels of the multimeric glycoprotein, von Willebrand factor (vWF) are associated with an increased risk of stroke and other cardiovascular diseases. vWF is responsible for inducing platelet adhesion and aggregation at sites of vascular injury, and for the protection of the blood-clotting protein, Factor VIII from proteolysis. vWF is regulated by ADAMTS13 (A Disintegrin And Metalloproteinase with a ThromboSpondin type 1 motif, member 13) that cleaves vWF into smaller, less reactive molecules. Previous reports suggest that modifiable lifestyle factors such as physical activity, diet and smoking can contribute to the variation in plasma levels of haemostatic markers. Taking into account the shift towards unhealthy lifestyles in the youth, we investigated the associations between vWF and ADAMTS13 with health behaviours, namely physical activity, alcohol consumption, smoking, obesity, salt intake, and socio-economic status in young black and white adults from South Africa. Methods: This study made use of the baseline data of the African-PREDICT study. We included 602 black and 594 white young adults aged 20-30 years. General Health and Demographic Questionnaires were used to report information on socio-economic status (SES), tobacco use, alcohol intake, and contraceptive use. Anthropometric measurements including weight, height and waist circumference were taken, and body mass index (BMI) was calculated. To determine physical activity, accelerometry was used by means of an ActiHeart monitor. Clinic and 24-hour blood pressure measurements were conducted using standard methods. Fasted citrated blood samples were used for the analysis of vWF:Ag and serum samples were used to measure ADAMTS13, cotinine and gamma-glutamyl transferase (GGT). Twenty four-hour urine samples were used to estimate daily salt intake. Results: Black adults had higher vWF:Ag and lower ADAMTS13 levels compared to whites (all p<0.001). Multiple regression analyses were carried out in the total group and then within each ethnic group. In the total group, vWF:Ag associated positively with BMI (β=0.09; p=0.037), while ADAMTS13 associated negatively with BMI (β=-0.10; p=0.016) and cotinine (β=-0.09; p=0.029); and positively with GGT (β=0.14; p=0.002). The vWF:Ag associated negatively with black ethnicity (β=-0.25; p<0.001) while ADAMTS13 associated positively with white ethnicity (β=0.23; p<0.001). When exploring within each ethnic group, vWF:Ag associated positively with estimated salt intake (β=0.12; p=0.043) only in the black group, and with BMI (β=0.14; p=0.023) only in the white group. Whereas, ADAMTS13 associated positively with GGT (β=0.22; p=0.003) and negatively with cotinine (β-0.14; p=0.041) in the white group. Conclusion: We found ethnic-specific associations between vWF and ADAMTS13 with obesity, salt intake, and smoking. Black individuals may have an increased thrombotic risk than whites, suggested by higher vWF:Ag and lower ADAMTS13 levels. Our findings suggest that in this young healthy population lifestyle factors already play a role in determining cardiovascular risk, thereby confirming the importance of maintaining a healthy lifestyle throughout ones’ lifespan.
- Health Sciences