Cardiometabolic disease in Black African and Caribbean populations: an ethnic divergence in pathophysiology?

Area of Science:

• Cardiology
• Genetics
• Immunology

Background:

• Black African and Caribbean (BAC) populations exhibit higher cardiometabolic disease (CMD) rates than White Europeans (WE).
• Obesity-induced visceral adipose tissue (VAT) and intrahepatic lipid (IHL) accumulation are linked to insulin resistance and inflammation, key CMD drivers.
• Current CMD theories inadequately explain the higher prevalence in BAC populations, who paradoxically show lower VAT/IHL and a more anti-inflammatory profile.

Purpose of the Study:

• To review current understanding of obesity's role in CMD.
• To highlight emerging evidence of ethnic divergence in CMD pathophysiology between BAC and WE populations.
• To investigate the potential role of complement system dysregulation in CMD disparities.

Main Methods:

• Literature review of existing studies on obesity, cardiometabolic disease, inflammation, and complement activation.
• Comparative analysis of pathophysiological mechanisms in Black African and Caribbean (BAC) versus White European (WE) populations.
• Exploration of ethnic differences in adipose tissue metabolism, inflammatory markers (TNF-α, IL-10), and complement system activity.

Main Results:

• BAC populations paradoxically present with lower VAT and intrahepatic lipid (IHL) despite higher CMD rates.
• BAC individuals may exhibit a more anti-inflammatory profile with lower TNF-α and higher IL-10.
• Recent findings indicate greater complement activation in BAC individuals compared to WE, suggesting its dysregulation is crucial.

Conclusions:

• Existing models of obesity-driven CMD do not fully account for ethnic differences observed in BAC populations.
• Complement system dysregulation emerges as a potential key factor driving higher CMD rates in BAC individuals.
• Further research into ethnic-specific pathophysiological mechanisms is essential for targeted CMD prevention and treatment.