Physicians' Academy for Cardiovascular Education

Associations between TG and cardiometabolic risk factors influenced by ancestral and environmental differences

Ancestral and environmental patterns in the association between triglycerides and other cardiometabolic risk factors

Literature - Meeks KAC, Bentley AR, Agyemang C, et al. - EBioMedicine. 2023;91:104548. doi: 10.1016/j.ebiom.2023.104548

Introduction and methods


Circulating triglyceride (TG) levels differ by ancestry and environment. For example, West Africans and African Americans of West African ancestry have lower TG levels compared with European ancestry populations in Europe and the US [1-3]. East Africans, on the other hand, show disproportionately high TG levels [4-8]. The relationship between TG levels and other cardiometabolic risk factors may differ between ethnic groups and within the same ethnic group living in distinct geographic environments due to genetic and environmental factors.

Aim of the study

The study aim was to compare the association between TG levels and known cardiometabolic risk factors and disorders (i.e., hypertension, systolic blood pressure (SBP), BMI, waist circumference, T2DM, and fasting glucose levels) across West African, East African, and European ancestry populations residing in 3 vastly different environmental settings (i.e., sub-Saharan Africa, the US, and Europe).


Data were used from the following 4 cross-sectional studies: (1) AADM (Africa America Diabetes Mellitus) study, which included West Africans (Ghana and Nigeria) and East Africans (Kenya); (2) RODAM (Research on Obesity and Diabetes among African Migrant) study, which included West Africans (Ghanaians) living in Ghana and Europe; (3) HELIUS (Healthy Life in an Urban Setting) study, which included Europeans, and 2 groups of West African ancestry (Ghanaians and African Surinamese) living in the Netherlands; and (4) NHANES (National Health and Nutrition Examination Survey) study, which included African Americans (West African ancestry) and European Americans in the US.

In total, 32,019 adults were included: people of West Africans ancestry living in sub-Saharan Africa (n=7201), the US (n=4390), or Europe (n=6436), those of East African ancestry living in sub-Saharan Africa (urban East Africans; n=781), and those of European ancestry living in the US (n=8670) or Europe (n=4541).

Main results

TG levels


Body composition

T2DM and fasting glucose levels


In this analysis comparing African and European ancestry populations who resided on one of 3 different continents, the associations between TG levels and hypertension, SBP, BMI, or waist circumference were stronger in European ancestry individuals compared with West African ancestry individuals with minimal or no influence by environmental context. In contrast, the associations of TG levels with T2DM or fasting glucose levels showed considerable variability by environmental context. The associations between TG levels and SBP, waist circumference, or T2DM differed between West African ancestry individuals and urban East Africans.

According to the authors, “[the a]ncestry differences [observed] could partially be attributed to variation in genetic factors underlying TG biology, while environmental differences likely reflect differences in health-related behaviors such as diet.” Moreover, their “findings imply that neither ‘African ancestry’ nor ‘European ancestry’ can be viewed as a single entity when discussing cardiometabolic risk.”


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