A health profile associated with excessive alcohol use independently predicts aortic stiffness over 10 years in black South Africans Melissa Maritz a , Carla M.T. Fourie a,b , Johannes M. van Rooyen a,b , Iolanthe M. Kruger c , and Aletta E. Schutte a,b Objective: Black populations exhibit higher arterial stiffness than whites and suffer a disproportionate burden of cardiovascular disease. It is therefore important to identify modifiable health behaviours predicting large artery stiffness in blacks. We examined whether traditional cardiovascular risk factors and health behaviours of black South Africans predict large artery stiffness 10 years later. Methods: We included 650 HIV-free participants (32.8% men) and collected data in rural and urban areas of the North West Province in 2005 and 2015. We collected questionnaire data, anthropometry, blood pressure and determined cardiometabolic and inflammatory markers from blood samples. We measured carotid–femoral pulse wave velocity (PWV) at follow-up. Results: A total of 25.3% of our population, aged 65  9.57 years, had a PWV exceeding 10 m/s. In multivariable-adjusted regression analyses, the strongest predictors of PWV were mean arterial pressure, age and heart rate (all P < 0.024). Urban locality (R 2 ¼ 0.31, b ¼ 0.12, P ¼ 0.001), self-reported alcohol use (b ¼ 0.11, P ¼ 0.018) and plasma glucose (b ¼ 0.08 P ¼ 0.023) associated positively with PWV at follow-up. We found a negative association between PWV and BMI (b ¼0.15, P ¼ 0.001), and no associations with sex, smoking, inflammatory markers, lipids, liver enzymes or antihypertensive medication. When replacing self-reported alcohol with gamma-glutamyltransferase, the latter associated positively with PWV (b ¼ 0.09, P ¼ 0.023). Conclusion: A health profile associated with excessive alcohol use, including an urban setting, elevated plasma glucose and lower BMI predicts large artery stiffness independently of age and blood pressure in black South Africans over 10 years. This observation prompts urgent public health strategies to target alcohol overuse. Keywords: alcohol use, arterial stiffness, black South Africans, longitudinal, pulse wave velocity, urban locality Abbreviations: AGE, advanced glycation endproducts; ALT, alanine aminotransferase; ANCOVA, analysis of covariance; ANOVA, analysis of variance; AST, aspartate aminotransferase; CKD-EPI, chronic kidney disease epidemiology collaboration equation; CrCl, creatinine clearance rate; CRP, C-reactive protein; eGFR, estimated glomerular filtration rate; GGT, gamma- glutamyltransferase; HbA1c, glycosylated haemoglobin; HDL-C, HDL cholesterol; IL-6, interleukin-6; MAP, mean arterial pressure; Naþ/Kþ ATPase, sodium -potassium ATP; PURE, prospective urban and rural epidemiology; PWV, pulse wave velocity; TC, total cholesterol; TG, triglycerides; TG/HDL-C, triglyceride to HDL cholesterol ratio; uACR, urinary albumin to creatinine ratio; WC, waist circumference INTRODUCTION B lack populations exhibit higher arterial stiffness than their white counterparts [1] and suffer a dis- proportionate burden of cardiovascular disease [2]. Large artery stiffness increases the risk of cardiovascular events, including stroke and myocardial infarction, cardi- ovascular and all-cause mortality [3]. Carotid–femoral pulse wave velocity (PWV) is the gold standard measurement of large artery stiffness [4] and is a better predictor of cardi- ovascular events, cardiovascular and all-cause mortality than brachial SBP and DBP, as well as brachial and 24-h pulse pressure [3,5]. Large artery stiffness is largely dependent on age [6] and blood pressure (BP) [7]. However, other factors may also accelerate vascular ageing beyond the effect of chronologi- cal age by functional and structural alterations of the arterial wall of conduit vessels [8]. In older white men, circulating inflammatory markers and the level of repetitive cyclic stress in the artery were predictive of arterial stiffness over 20 years, whereas traditional cardiovascular risk factors had only a modest effect [9]. After 17 years, abdominal obesity, Journal of Hypertension 2017, 35:000–000 a Hypertension in Africa Research Team (HART), b MRC Unit for Hypertension and Cardiovascular Disease and c Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa Correspondence to Prof Carla M.T. Fourie, Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom 2520, South Africa. Tel: +27 18 299 2080; fax: +27 18 285 2432; e-mail: carla.fourie@nwu.ac.za Received 15 February 2017 Revised 23 April 2017 Accepted 30 May 2017 J Hypertens 35:000–000 Copyright ß 2017 Wolters Kluwer Health, Inc. All rights reserved. DOI:10.1097/HJH.0000000000001452 Journal of Hypertension www.jhypertension.com 1 Original Article Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.