Examining How Our Shared Evolutionary History Shapes Future Disease Outcomes

Abstract

Cardiometabolic diseases are major contributors to mortality and morbidity, and their burden displays global and regional disparities. Gene-environment interactions contribute to the pathogenesis of cardiometabolic diseases. Population differences in genetic structure, ancient environmental pressures that shape the human genome, and early life environmental adversities (e.g., in utero conditions) all contribute to observed disparities in global cardiometabolic diseases. The genetic and socio-cultural diversity of global populations presents opportunities for discovering genomic loci that influence cardiometabolic diseases as illustrated by a few genetic, epigenetic, and population-genetic discoveries leading to notable understanding of disease mechanisms. However, African, Latin American and Hispanic, and indigenous peoples represent less than 4% of all genome-wide association study samples analyzed to date. Using examples of recent studies in African populations, we discuss the crucial importance of conducting genomic studies in ancestrally diverse populations to understand disease mechanisms and to prepare fertile ground for future delivery of precise health care to all individuals.

An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa

“…Although many countries have stabilized their HIV epidemics, curtailing the high burden of new HIV infections in many African countries (including South Africa, Nigeria, Uganda, Swaziland, Lesotho, and Zimbabwe) remains a challenge. Moreover, little is known about the number of PWH with comorbidities, including smoking-related conditions in Africa, even as tobacco use continues to rise [ 107 , 108 ]. There is an urgent need for both epidemiological data and the application of implementation research strategies with a focus on health equity to help researchers, policymakers, and healthcare workers understand and address this emerging syndemic.…”