Racial and regional disparities in the risk of noncommunicable disease between sub-Saharan black and European white patients

Abstract

Objectives: Greater vulnerability of Black vs. White individuals to cardiovascular disease (CVD) and chronic kidney disease (CKD) is well charted in the United States, but studies involving sub-Saharan blacks are scarce.

Methods: Baseline data (2021-2024) were collected in 168 sub-Saharan Blacks and 93 European Whites in an ongoing clinical trial (NCT04299529), using standardized patient selection criteria. Data included clinical and biochemical risk factors, ECG and echocardiographic traits, Framingham CVD risk, CKD grades (KDIGO 2024), self-assessed symptoms (WHO questionnaire), and urinary proteomic profiles predictive of left ventricular dysfunction (LVD) and CKD, HF1, and CKD273, respectively. Racial comparisons rested on unadjusted and multivariable-adjusted analyses.

Results: Despite being younger (60.4 vs. 68.3 years), blacks had a worse risk profile, as evidenced by higher diabetes prevalence, higher BMI, faster heart rate, unfavourable serum cholesterol fractions, lower estimated glomerular filtration rate, microalbuminuria, and sedentary lifestyle. This resulted in blacks having higher 10-year CVD risk, higher heart age (index of vascular ageing with chronological age as reference), and a worse CKD grades. In both races, CKD273 increased with CKD grade, but CKD273 and HF1 were not different by race. These observations were robust in subgroup and adjusted analyses.

Conclusion: This study did not differentiate host (genetic, molecular, and pathogenic) from environmental drivers of disease. Nonetheless, the findings call for a multipronged and comprehensive implementation of innovative health policies in sub-Saharan countries. Education, research, empowerment of stakeholders, and international learned societies connecting experts from a wide array of disciplines should vigorously sustain this effort.

Graphical abstract

FIGURE 1

Consort diagram showing patient disposition, including screening, randomisation, and selection of patients for the current analyses.

FIGURE 2

Ten-year CVD risk (a) and heart age (b) by race according to the Framingham risk scores and the distributions of age and heart age in 168 Blacks (c) and 93 Whites (d). The sex-specific Framingham scores in (b) are derived from chronological age, total serum cholesterol, HDL serum cholesterol, SBP, antihypertensive treatment status (yes vs. no), smoking (yes vs. no), and diabetes (yes vs. no). In (a) and (b), the height of the bars represents means (numerical value given) and the vertical lines the SD. The asterisk in (a) indicates a significant difference in the 10-year CVD risk between Blacks and Whites in patients aged ≥70 years. (c) and (d) show the overlay in the distributions of chronological age and heart age in Blacks (c) and Whites (d). In both races, heart age was significantly higher than chronological age. The brown colour indicates the overlay in the distributions of chronological and heart age.

FIGURE 3

Grades of chronic kidney disease derived from the estimated glomerular filtration rate and albuminuria by race. The CKD grade is derived by cross-classification of eGFR and albuminuria, according to the 2024 KDIGO Guideline. Albuminuria is expressed in milligram per litre or per gram creatinine depending on the method of measurement. (a,b) present the number of patients (%) in cross-classified cells by race. (c,d) depict the percentage of patients at different CKD grades by age. The Spearman rank correlation coefficients between the CKD stage and age are -0.13 (P = 0.099) in blacks and 0.23 (P = 0.041) in whites.