CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 5, September/October 2022 234 AFRICA Association of microalbuminuria with serum lipids and inflammatory markers in an adult population in the Dikgale Health and Demographic Surveillance System site, South Africa Thabo Magwai, Perpetua Modjadji, Solomon Choma Abstract Background: There is evidence that microalbuminuria (urinary albumin excretion) is an early sign of vascular damage and an established risk factor for cardiovascular morbidity and mortality. This study investigated the magnitude of microalbuminuria and its association with serum lipids and inflammatory markers among a rural black population residing in the Dikgale Health and Demographic Surveillance System site, South Africa. Methods: Data were collected from 602 presumably healthy participants (225 men and 377 women) aged ≥ 18 years. Biochemical data collection included serum lipids, glucose, insulin, high-sensitivity C-reactive protein (hs-CRP), urine albumin and creatinine. Anthropometry and blood pressure were also measured. Microalbuminuria was diagnosed with an albumin–creatinine ratio of ≥ 2.5 mg/mmol in men and ≥ 3.5 mg/mmol in women. Data were analysed using SPSS version 22.0. Results: The mean age of participants was 48.63 ± 20.89 years. High percentages of microalbuminaria (35.7%), high levels of interleukin 6 (17.8%), hs-CRP (32.9%), triglycerides (TG) (26.1%), low-density lipoprotein cholesterol (52.2%) and total cholesterol (32.0%), and low levels of high-density lipoprotein cholesterol (29.1%) were observed in the population. Increased glucose levels (32.8%), insulin resistance (27.6%), hypertension (45.8%), overweight (26.8%) and obesity (25.4%) were also prevalent. Microalbuminuria was associated with high hs-CRP and TG levels in the men (adjusted odds ratios = 9.434, 95% confidence interval: 1.753 – 50.778, p = 0.01). Conclusion: High prevalence of microalbuminuria, hypertension, insulin resistance, overweight and obesity, as well as abnormal levels of serum lipids and inflammatory markers were observed in the population. Microalbuminuria was associated with high hs-CRP and TG levels among men. Keywords: microalbuminuria, serum lipids, inflammatory markers, rural HDSS site, South Africa Submitted 18/5/20, accepted 6/1/21 Published online 12/4/22 Cardiovasc J Afr 2022; 33: 234–242 www.cvja.co.za DOI: 10.5830/CVJA-2021-055 In 2018, the World Health Organisation (WHO) reported that South Africa faces a quadruple burden of disease resulting from communicable diseases (HIV/AIDS and tuberculosis), maternal and child mortality, non-communicable diseases (NCDs) such as hypertension and cardiovascular diseases (CVDs), diabetes mellitus, cancer, mental illnesses and chronic lung diseases such as asthma, as well as injury and trauma.1 Most of the CVD deaths (80%) occur in low- to middle-income countries. In South Africa, NCDs are estimated to account for 43% of the total adult deaths, while CVDs account for almost a fifth (18%) of these deaths.2 One in three South African adults (33.7%) has hypertension, which can increase the risk of heart attack, heart failure, kidney disease or stroke, while 31.3% of adults are obese.2 Contributing factors to CVDs are urbanisation and the population burden of vascular risk factors, such as hypertension, hypercholesterolaemia, low-grade inflammation, as well as diabetes, smoking and obesity.3,4 Microalbuminuria (MA) is an established risk factor for cardiovascular morbidity and mortality and for end-stage renal disease in individuals with associated cardiovascular risk conditions such as hypertension or/and diabetes mellitus.5,6 The leakage of albumin into the urine is thought to be linked to enhanced capillary permeability for albumin in the systemic vasculature and this might lead to haemodynamic strain and instability, which then starts the atherosclerotic process, eventually leading to adverse cardiovascular events.7-9 Another explanation could be endothelial dysfunction, since abnormalities in the endothelial glycocalix can contribute to both MA and the pathogenesis of atherosclerosis, therefore providing a link between MA and CVDs.10 In a South African study, the prevalence of MA was reported to be 58% in the general population, 51% in a diabetic population and 43% in a hypertensive population.11 One of the most significant markers of inflammation appearing during atherosclerosis is C-reactive protein (CRP). This is formed in the liver in response to the development of an inflammatory condition or is due to infection.12 There is a significant relationship between an increased high-sensitivity CRP (hs-CRP) and local disturbances in the structure and function of blood vessels, particularly with abnormal lipid status.13 MA has been associated with high levels of hs-CRP14 and interleukin 6 (IL-6).15 Department of Pathology and Medical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, South Africa Thabo Magwai, MSc, thabo.magwai9096@outlook.com Perpetua Modjadji, MSc, PhD, DrPH Solomon Choma, MSc Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, South Africa Perpetua Modjadji, MSc, PhD, DrPH
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