🌡️ NWU's Breakthrough in Profiling Risk Factors and Biomarkers

Researchers from North-West University's Hypertension in Africa Research Team (HART) have made significant strides in understanding the early stages of cardiovascular disease (CVD). Their recent publication in Hypertension Research, a prestigious journal under the Nature Portfolio, responds to ongoing discussions by outlining a shift from isolated risk factors to interconnected causal pathways in biomarker studies. This work builds on baseline data from the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT), involving over 1,200 young adults aged 20-30 in South Africa.

The study highlights how individual cardiovascular risk factors like high blood pressure, obesity, and dyslipidemia correlate with circulating biomarkers related to endothelial function, oxidative stress, and inflammation. Endothelial function refers to the health of the inner lining of blood vessels, which regulates blood flow and prevents clotting. Oxidative stress occurs when there's an imbalance between free radicals and antioxidants in the body, damaging cells and contributing to atherosclerosis—the buildup of plaques in arteries. Inflammation markers, such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP), signal low-grade systemic responses that accelerate vascular damage.

In South Africa, where CVD accounts for nearly 18% of all deaths and hypertension affects over 27% of adults, early intervention is critical. Traditional risk assessments often miss subclinical changes in young people, but biomarkers offer a window into these hidden processes.

The African-PREDICT Study: A Longitudinal Lens on Early CVD

Launched by NWU's HART team, the African-PREDICT study recruits apparently healthy black and white South Africans to track the progression from normal physiology to hypertension and CVD over 10-20 years. Participants undergo comprehensive assessments including blood pressure monitoring, vascular imaging, blood tests for biomarkers, and lifestyle evaluations. This cohort design allows researchers to capture data at baseline and follow-ups, recently completed, providing robust evidence on predictive markers.

Key to the study is identifying deviations before clinical symptoms emerge. For instance, pulse pressure amplification (PPA)—the difference between central and brachial pulse pressure—serves as a non-invasive measure of arterial stiffness and wave reflection. Lower PPA in overweight and obese participants was linked to elevated inflammatory biomarkers like leptin, TNF-α, and CRP, but not in normal-weight groups. Leptin, produced by fat cells, regulates appetite but in excess promotes inflammation; CRP rises with vascular injury.

• Overweight/obese groups showed adverse inflammatory profiles (higher TNF-α, leptin, CRP; lower adiponectin).
• PPA negatively associated with these markers only in excess adiposity contexts.
• No pulse wave velocity (PWV) differences, suggesting early functional changes precede stiffness.

This underscores adiposity-inflammation-arterial function links, vital for prevention in SA's youth facing rising obesity rates (13% adults obese, per SA Health Dept. 2023).

Defining Cardiovascular Biomarkers: Tools for Precision Detection

Cardiovascular biomarkers are measurable molecules in blood or urine indicating heart and vessel health. They fall into categories: structural (e.g., troponin for myocyte damage), functional (e.g., BNP for heart strain), inflammatory (CRP, IL-6), oxidative (malondialdehyde), and endothelial (asymmetric dimethylarginine or ADMA). In early detection, subclinical elevations predict events years ahead.

NWU's work profiles a panel including IL-6, IL-8, TNF-α, adiponectin, IL-10, CRP, leptin, and oxidative markers like F2-isoprostanes. Cross-sectional analyses reveal risk factor-specific patterns: hypercholesterolemia ties to endothelial dysfunction; hyperglycemia to oxidative stress. Step-by-step, these biomarkers reflect processes: risk exposure → endothelial injury → oxidative burst → chronic inflammation → plaque formation.

In SA context, where urbanization drives metabolic shifts, such panels enable risk stratification beyond Framingham scores, which underperform in African populations due to genetic/environmental differences.

Key Findings from NWU's Nature Portfolio Publications

Adriaan Jacobs' response in Hypertension Research (2026) addresses limitations of single-risk associations, advocating causal pathway models using longitudinal data. The original paper profiled biomarkers across risks, finding consistent links but calling for predictive validation.Read the full response

Companion study on PPA (2026) in Journal of Human Hypertension analyzed 1,202 participants: PPA lower in overweight/obesity (p<0.001), associated with TNF-α (β=-0.125, p=0.025 in overweight), leptin, CRP. Multivariate models adjusted for age, sex, ethnicity confirm inflammation mediates adiposity's vascular effects.

• Obesity group: leptin β=-0.359 (p<0.001) with PPA.
• Adiponectin protective (β=0.262, p<0.001 in obesity).
• Waist-to-height ratio stratification reinforces central obesity risks.

These pinpoint inflammation as modifiable target.Explore research careers

CVD Burden in South Africa: Why Early Detection Matters

South Africa faces a CVD epidemic: 200,000+ deaths yearly, hypertension prevalence 46% in blacks vs. 22% whites (SADH 2022). Youth onset rising with 30% overweight by age 25. Economic cost: R20bn+ annually in treatments. Biomarkers enable pre-hypertensive screening, potentially averting 40% events via lifestyle/drug interventions.

NWU's Potchefstroom cohort mirrors national demographics, enhancing generalizability. Real-world case: Participant with elevated CRP/leptin despite normal BP flagged for monitoring, preventing progression.

Stakeholder Perspectives: From Researchers to Policymakers

HART leader Prof. Aletta Schutte praises the shift to pathways: "Single biomarkers miss complexity; combinations predict better." SA Heart Foundation endorses integration into primary care. Patients benefit from actionable insights: diet/exercise targeting inflammation halves risk.

Challenges: Assay costs, standardization in low-resource settings. Solutions: Point-of-care tests, AI-multiomica panels.Original profiling study

Technological Advances and Methodologies in Biomarker Research

NWU employs tonometry for pulse wave analysis, ELISA/multiplex for biomarkers, metabolomics for pathways. Step-by-step PPA measurement: Applanation tonometer captures radial waveform → generalized transfer function derives aortic → ratio computes amplification. Reliability high (ICC>0.9).

Future: Proteomics/genomics integration via machine learning for personalized risk scores.

Implications for Clinical Practice and Public Health

Validated biomarkers could screen SA's 20M+ workforce, prioritizing high-risk youth. Cost-benefit: R100 biomarker panel vs. R50,000 MI treatment. Pilots in NW Province clinics planned.

• Reduce hypertension incidence 25% via early drugs (ACEi/statins).
• Lifestyle: Anti-inflammatory diets (Mediterranean adapted for SA).
• Equity: Address racial disparities in biomarker responses.

Links to SA higher ed jobs in research.

Future Outlook: From Pathways to Prevention

Jacobs outlines using African-PREDICT follow-ups for prediction models, multi-omics causal inference. Global collab potential: Integrate with INTERHEART Africa. By 2030, biomarker-guided screening could cut SA CVD mortality 30%.

NWU positions as CVD research hub, attracting funding/talent. Explore research positions or professor ratings.

Photo by Robina Weermeijer on Unsplash

In summary, NWU's Nature publication illuminates biomarker pathways, paving early detection revolution. For careers in this field, check higher ed jobs, university jobs, career advice, rate professors.