Haemostatic variables in African adolescents : the PLAY study / Cornelie Nienaber
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Cardiovascular disease (CVD) is a major cause of adult morbidity and mortality in developed as well as in developing countries. In black population groups, stroke is more prominent than ischaemic heart disease. This may be attributed to a combination of risk factors seen in this population group inter alia raised haemostatic markers, which favour the development of stroke since it is well known that a disturbance in the haemostatic balance (a hypercoagulable and a hypofibrinolytic state) predisposes to CVD. It is generally accepted that childhood genetic, environmental and behavioural factors lay the groundwork for the manifestation of adult CVD. Therefore, one of the studies that form part of this dissertation was a cross-sectional study to determine whether haemostatic abnormalities are already present in black African adolescents and to determine whether high risk groups exist [in relation to the following haemostatic markers: fibrinogen, factor VIII (FVIII), plasminogen activator inhibitor type 1 activity (PAI-Iact), and thrombin anti-thrombin complex (TAT)] for the development of CVD later in life. The population subdivisions were made according to gender, body fat %, maturity status, height for age Z-score, and habitual PA levels. Since behavioural factors [diet, physical activity (PA), smoking and drinking habits] are controllable determinants, it could be possible to improve CVD risk to a certain degree. Therefore, the second study that forms part of this dissertation attempted to establish whether a PA programme will successfully reduce haemostatic variables in a subset of the study population used in the first study. The reader is referred to the abstracts at the beginning of each separate study manuscript (Chapters 3 and 4), for a description of the subjects, study design and methods used in each study. The results of the cross-sectional study showed that in African adolescents (a) gender independently contributed to the variability in PAI-Iact, but that the gender difference in fibrinogen and TAT could be explained by the significant differences in fat mass and PA levels observed between the genders; (b) fibrinogen was significantly higher in the stunted compared to the non-stunted children indicating that childhood chronic malnutrition may possibly predispose independently to CVD; (c) fitness influences TAT concentrations positively and that (d) no significant differences in FVIII could be found between any of the subdivisions. As these determinants seem to be modifiable through behavioural changes and optimal nutrition status through early life, it raises a sense of urgency to develop strategies for the prevention and treatment of these risk factors. The results of the intervention study showed that an 11-week outdoor PA intervention programme had no significant effect on the haemostatic markers of African adolescents, but the results of this study should be interpreted with caution since (a) seasonal variations could have clouded the effect of the PA intervention as baseline measurements were taken in the summer and end measurements in the winter; (b) attendance of the PA sessions does not necessarily implicate compliance to the exercises given; (c) baseline values seem to play a prominent role in the changes that could be expected during an intervention and, therefore, improvements in the haemostatic profile would most likely be more significant in individuals with raised baseline levels. Similar research on African children is warranted since studies investigating PA's effect on haemostatic variables remain a topic of debate and speculation and data on African population groups are scanty.
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