Beyond the traditional risk factors for cardiometabolic diseases among transitioning African populations: An investigation into novel epidemiological and epigenetic factors

Sub-Saharan African (SSA) populations are experiencing epidemiological transitions due to rapid urbanization and international migration; often from low income to high income countries (HICs). As such, cardiometabolic diseases are rapidly becoming the leading causes of morbidity and mortality among these migrant and non-migrant SSA populations. To date, changes in lifestyle factors (e.g., tobacco smoking, alcohol consumption, poor diet, and physical inactivity) are the more prominent contributors to the emerging risk of cardiometabolic diseases. Despite concerted efforts to control these lifestyle factors, the burden of cardiometabolic diseases continues to rise in SSA populations. It is plausible that other non-traditional risk factors for cardiometabolic disease are at play, but it is not yet known what these factors are. This thesis therefore aimed to unravel novel epidemiological and epigenetic factors contributing to the emerging burden of cardiometabolic diseases in migrant and non-migrant SSA populations. We find that the burden of cardiometabolic diseases among migrant and non-migrant SSA populations results from a complex interplay of factors as opposed to just the traditional risk factors. Contexual factors that were previously not attributed to cardiometabolic diseases in SSA populations such as psychosocial stress, serum uric acid, a lean body weight, chronic inflammation, DNA methylation and epigenetic age acceleration all contribute to the growing burden of these diseases. With further studies, these novel epidemiological and epigenetic factors will enable development of innovative interventions for cardiometabolic diseases in SSA populations.