The HART group is actively busy with five running projects in conjunction with many collaborators and other research entities.
These studies are:
Principal Investigator: Prof AE Schutte
African-PREDICT (African PRospective study on the Early Detection and Identification of Cardiovascular disease and HyperTension)
The African-PREDICT study is a longitudinal study that started in 2013, and is expected to continue for the next 10-20 years. A total of 1200 young and healthy, normotensive black and white participants (aged 20-30 years) are included to track the development of cardiovascular deterioration and hypertension development.
The study is profiled on ResearchGate: https://www.researchgate.net/project/African-PREDICT-study-African-Prospective-study-on-the-Early-Detection-and-Identification-of-Cardiovascular-disease-and-Hypertension
Building on the existing knowledge gained from epidemiological studies, the African-PREDICT study aims to understand the early pathophysiology accompanying disease development, and to identify novel early markers or predictors for the development of cardiovascular disease in black South Africans. By evaluating conventional and possible novel markers in risk scores, we may identify more effective and sensitive screening indicators, predictors or targets for intervention, which could be implemented as part of successful prevention programmes in Africans at younger ages.
To achieve this we perform detailed cardiovascular and novel biomarker measurements, as well as behavioural and biopsychosocial assessments every 5 years in order to identify and understand early changes in cardiovascular function, and specific predictors contributing to the development of hypertension and target organ damage.
A large transdisciplinary national and international team of scientists collaborate in this study.
The research project is financially supported by the South African Medical Research Council (SAMRC) with funds from National Treasury under its Economic Competitiveness and Support Package; the South African Research Chairs Initiative (SARChI) of the Department of Science and Technology and National Research Foundation (NRF) of South Africa; the Strategic Health Innovation Partnerships (SHIP) Unit of the SAMRC with funds received from the South African National Department of Health, GlaxoSmithKline R&D, the UK Medical Research Council and with funds from the UK Government’s Newton Fund; as well as corporate social investment grants from Pfizer (South Africa), Boehringer-Ingelheim (South Africa), Novartis (South Africa), the Medi-Clinic Hospital Group (South Africa) and in kind contributions of Roche Diagnostics (South Africa).
The SABPA study
Principle Investigator: Prof L Malan
The Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) Prospective Cohort study
The evidence in more than 10 000 Africans of the North-West Province of South Africa that taxing environmental demands may be detrimental to their cardio-metabolic health, motivated the design of the SABPA Prospective cohort study. The main aim of the study was to determine neural mechanistic pathways involved in emotional distress, cardio-metabolic risk and target organ damage in the brain, retina, heart and kidneys. The study received an international award for study design excellence in 2008 from the International Diabetes Federation (IDF).
The participant sample included 409 Black and White male and female teachers (aged 20-65 years) who were recruited from all enrolled teachers (N=2170) from 43 schools of the Dr Kenneth Kaunda Education District (Potchefstroom and Klerksdorp), North-West Province, South Africa. The first phase of the study was conducted in 2008-2009 and the second in 2011-2012, with an 87.8% successful follow-up rate. The assessment periods were selected to avoid seasonal changes. Each participant took part in a battery of clinical assessments performed during a 48 hour period under well-controlled conditions. Several grants were received from the North-West University; the National Research Foundation (NRF) and Medical Research Council (MRC); the North-West Department of Education and ROCHE Diagnostics, South Africa.
Our research and data dissemination are supported by an extensive network of expert national, international and pharmaceutical collaborators. This network-relationship is based on respect, trust and integrity which are clearly evident in the sponsored biochemical analyses and numerous peer-reviewed publications.
The PURE study
Principle Investigators for the Cardiovascular Assessments in PURE: Prof CMT Fourie and Prof AE Schutte
The Prospective Urban and Rural Epidemiology (PURE) study is a longitudinal, multinational study including 17 low-, middle- and high-income countries of the world. The study will track changes in lifestyles, cardiovascular disease risk factors and chronic diseases over a period of at least 10 years, using standardized data collection in rural and urban areas. The baseline data collection of the South African leg of the PURE study was executed in 2005 in the North West Province and included 2010 randomly recruited (from an urban and rural setting) African volunteers older than 35 years. The five years follow-up data collection took place in 2010 and the ten year follow-up data collection in 2015.
Top articles from the HART group:
- Are behavioural risk factors to be blamed for the conversion from optimal blood pressure to hypertensive status in Black South Africans? A 5-year prospective study.
- Lipid abnormalities in a never-treated HIV-1 subtype C-infected African population.
- Urinary albumin excretion from spot urine samples predict all-cause and stroke mortality in Africans.
- Evaluation of waist-to-height ratio to predict 5 year cardiometabolic risk in sub-Saharan African adults.
- Self-reported alcohol intake is a better estimate of 5-year change in blood pressure than biochemical markers in low resource settings: the PURE study.
The HART group started with HIV and cardiovascular risk research in the PURE study on 300 HIV infected and 300 gender, age, locality and BMI matched HIV free participants. A mini follow-up study was executed on this group in 2008. Several articles were published on this topic:
- Is HIV-1 infection associated with endothelial dysfunction in a population of African ancestry in South Africa?
- HIV infection and cardiovascular risk in black South Africans.
- Soluble Urokinase Plasminogen Activator Receptor (suPAR) is associated with Metabolic Changes in HIV-1-Infected Africans: A Prospective Study.
- Cardiometabolic markers to identify cardiovascular disease risk in HIV-infected black South Africans.
- The five year cardiometabolic changes in treated versus never treated HIV-infected black South Africans: the PURE study.
The ASOS project
Principle Investigator: Prof R Kruger
The Arterial Stiffness in Offspring Study (ASOS) is a cross-sectional, observational study that investigates the trends of elevated blood pressure, arterial stiffness and body composition in young school children between the ages 6 and 8 years. Our research indicated that the black population is more burdened with high blood pressure and arterial stiffness at an earlier age compared to the white population. This raised the question about the age at which changes in the cardiovascular system starts in black compared to white people. We chose 6 to 8 year old boys specifically since we have observed that differences in 10 to 15 year old black and white children are already present. Therefore, the earlier we can detect differences, the sooner interventions could be developed to curb this disease burden among the black South African population.
The ASOS project is funded by the South African Sugar Association (SASA), National Research Foundation (NRF) of South Africa and the Medical Research Council (MRC) Extramural Research Unit for Hypertension and Cardiovascular Disease.
The EndoAfrica project
Principal Investigator EndoAfrica study: Prof Carla Fourie
EndoAfrica study: The putative interface of emerging cardiovascular risk factors affecting populations living with and without HIV in Sub-Saharan Africa.
The EndoAfrica study is a collaboration between Prof. Hans Strijdom at Stellenbosch University, Medical University Gräz (Austria), VITO NV, Hasselt University (Belgium), HART NWU (Potchefstroom) and Walter Sisulu University (Umtata).
The aim of the study is to examine the interaction between HIV-infection, antiretroviral treatment (ART) and cardiovascular risk in South African adults. The study particularly focuses on endothelial dysfunction as an early predictor of cardiovascular disease. A total of 270 HIV-infected and 90 HIV-free South African adults will be recruited by each of the three centres of the study; HART (North West Province), Walter Sisulu University (Eastern Cape) and Stellenbosch University (Western Cape). HIV status and ART use will be documented and measurements of cardiovascular health taken with sensitive apparatus.
Measures include flow mediated dilatation, arterial stiffness by pulse wave velocity, structural endothelial changes by sonar imaging of the carotid intima media, retinal imaging, and screening for hypertension, diabetes, obesity, dyslipidaemia and smoking, along with the analysis of vascular inflammation biomarkers in blood. All measures will be repeated after 18 months to evaluate the influence of HIV infection and ART on cardiovascular risk.
The study is discussed briefly on LinkedIn:
Building on the existing knowledge gained from populations outside of sub-Saharan Africa, the EndoAfrica study aims to understand how HIV and ART affects the interaction between communicable and non-communicable disease in South Africans where both HIV and cardiovascular disease are highly prevalent.
The Department of Science and Technology of the Republic of South Africa is funding the HART (NWU) part of the EndoAfrica study.