Hypertension Susceptibility in African Migrants: Solving the puzzle through transcontinental prospective cohort study design

Project Information

Pros-RODAM

Grant agreement ID: 772244

DOI

10.3030/772244

Project closed

EC signature date 31 January 2018

Start date 1 March 2018

End date 31 August 2023

Funded under

• EXCELLENT SCIENCE - European Research Council (ERC)

Total cost

€ 1 999 438,00

EU contribution

€ 1 999 438,00

Coordinated by

STICHTING AMSTERDAM UMC
Netherlands

Periodic Reporting for period 4 - Pros-RODAM (Hypertension Susceptibility in African Migrants: Solving the puzzle through transcontinental prospective cohort study design)

Reporting period: 2022-09-01 to 2023-08-31

Summary of the context and overall objectives of the project

Cardiovascular disease (CVD) is one leading causes of death in the European Union (EU) accounting for 1.9 million deaths, an equivalent to 40% of all deaths each year in the EU. It is also the major health problem confronting ethnic minorities and migrants in Europe, and the CVD incidence and mortality in these groups are higher than in the European local populations. This inevitably contributes to the widening health inequalities. Sub-Sahara African (SSA) migrants, particularly West-Africans, have been particularly affected with stroke being 1.5–2.5 times more common in these groups than in the European host populations. Hypertension is the most important modifiable cardiovascular risk factor. Migrants, especially people of Sub-Saharan African heritage, are extremely affected by hypertension. Unfortunately, for so long, the underlying reasons for the increased risk still remain a mystery. The lack of understanding of the underlying determinants is hindering policy makers’ and clinical efforts in addressing the problem head-on. This is happening at a time when preventive measures have led to reduction in hypertension and improved hypertension control in the European general populations for the last few decades, and the mortality of CVD has declined impressively, with more than 50% in many European countries. More evidence on the underlying factors is clearly needed in order to develop adequate policy, clinical and public health responses to minimise the high burden of hypertension and related complications among the growing ethnic minority and migrant populations in Europe.

The Pros-RODAM project therefore aims to understand the mechanisms underlying the high risk of hypertension among African migrants by assessing the role of epigenetic modifications that result from rapid socio-environmental and behaviour change.

The key objectives are:
1. To identify environmental factors and epigenetic modifications associated with hypertension prevalence in SSA subjects;
2. To assess the causality of these associations using longitudinal data on changes in epigenetic and environmental factors and hypertension incidence;
3. To assess the influence of (change in) environmental factors to changes in epigenetic modifications;
4. To assess the contribution of epigenetic modifications, together with environmental factors, to differences in hypertension risk between migrant and non-migrants (i.e. Europeans and SSA compatriots living in Africa);
5. To use findings to inform targeted prevention, and to provide basis for improving hypertension diagnosis and treatment.

The Pros-RODAM study will provide a sound basis for targeting hypertension prevention and treatment and thereby delivering major breakthroughs in addressing the problem head-on in African migrants and beyond.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

• The cross-sectional RODAM study has been successfully transformed into a longitudinal, transcontinental cohort study, among migrants and non-migrants: the RODAM Prospective (Pros-RODAM) study.
• In total, 638 Ghanaians residing in rural Ghana, 608 Ghanaians residing in urban Ghana, 919 migrant Ghanaians in Europe, and 2098 European Dutch have been included in the studied despite the challenges of the COVID-19.
• Extensive data have been collected based on highly standardized procedures, including questionnaires, physical examination, and biological sample collection in all research participants.
• All biological samples have been shipped from Ghana to Amsterdam following highly standardized procedures, and biochemical analysis has been completed. A biobank has been established at the Amsterdam UMC for future analysis of samples.
• The Pros-RODAM statistical dataset for statistical analysis has been compiled and cleaned, and first analysis of the longitudinal data has commenced. Over 20 scientific papers are currently being prepared based on the Pros-RODAM study, aiming to answer the main Pros-RODAM research questions (prevalence and incidence of hypertension, factors associated with incident hypertension, epigenetic modifications associated with hypertension), or focusing on other cardiovascular risk factors and their determinants like diabetes mellitus, obesity, chronic kidney disease, and dyslipidaemia.
• DNA isolation and DNA methylation profiling has been completed using the Infinium® Methylation EPIC BeadChip of Illumina (850K). The DNA methylation data have been cleaned, and first analyses have commenced.
• The dissemination plan to share the study results with the research participants is currently being developed, and results will soon be shared with participants both in Amsterdam and in Ghana.
• The Pros-RODAM team has built a strong collaboration with the African migrant communities in the Netherlands and regularly provides health education information to the African communities through community organizations.
• For all participants, we requested permission to contact them for participation in future research, allowing us to follow them up over time, beyond this round of data collection.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

We have successfully established the first transcontinental longitudinal prospective cohort of a homogenous migrant group and non-migrants from their country of origin in Africa, allowing us to identify key social, economic, psychosocial and lifestyle factors. In this longitudinal design, we also included epigenetic data to assess the interaction between genetic background and environmental factors, which will help to elucidate drivers behind the high burden of hypertension. This is beyond the state of the arts, as longitudinal studies in the field of migration and health have not been completed before, and epigenetic studies most of the times have a cross-sectional design and a smaller sample size.

The establishment of transcontinental prospective cohort will have major long-term impact on migrant health research as it will open novel fields and raise new possibilities for research on several health outcomes and social determinants of health among migrants in Europe and non-migrant living in rural and urban Africa.

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