Ideal Cardiovascular Health and Carotid Atherosclerosis in a Mixed Cohort of HIV-Infected and Uninfected Ugandans

Abstract

Preventable cardiovascular disease (CVD) risk factors are responsible for the majority of CVD-related deaths, and are increasingly recognized as a cause of morbidity and mortality for HIV-infected persons taking antiretroviral therapy (ART). Simplified tools such as the American Heart Association's ideal cardiovascular health (iCVH) construct may identify and prognosticate CVD risk in resource-limited settings. No studies have evaluated iCVH metrics in sub-Saharan Africa or among HIV-infected adults. Thus, the central aim of this study was to compare levels of iCVH metrics and their correlations with carotid atherosclerosis for HIV-infected adults versus uninfected controls in a well-phenotyped Ugandan cohort. We analyzed the prevalence of iCVH metrics in a mixed cohort of HIV-infected persons on stable ART and uninfected, population-based comparators in Mbarara, Uganda. We also assessed the validity of iCVH by correlating iCVH values with common carotid intima media thickness (CCIMT). HIV-infected persons had a mean of 4.9 (SD 1.1) iCVH metrics at ideal levels versus 4.3 (SD 1.2) for uninfected controls (p = .002). This difference was largely driven by differences in blood pressure, blood glucose, and diet. In multivariable-adjusted linear regression models, each additional iCVH metric at an ideal level was associated with a significant 0.024 mm decrease in CCIMT (p < .001).HIV-infected persons on ART in rural Uganda had more iCVH metrics at ideal levels than uninfected persons. The difference appeared driven by factors that are putatively influenced by access to routine medical care. Composite scores of iCVH metrics were associated with subclinical atherosclerosis and more predictive of atherosclerosis for uninfected persons.

Blood pressure trajectories and the mediated effects of body mass index and HIV‐related inflammation in a mixed cohort of people with and without HIV in rural Uganda

“…This is similar to, though larger in magnitude, a previous cross‐sectional finding in Uganda in which BMI mediated over 25% of the association between HIV and SBP . BMI appears to be a major contributor to the BP increase among people with HIV partly due to better access to care and healthier lifestyles (more exercise, cessation of smoking, and less salty/fatty diets) . Though HIV infection is associated with weight loss via multifactorial mechanisms including socioeconomic status, access to care, cultural practices, psychological factors, HIV virus, and ART, stabilization on ART leads to weight gain termed “trend toward normal weight.” Though beneficial to health recovery and return to pre‐HIV workforce productivity, this represents a trend toward overweight and obesity and later blood pressure increase …”

“…The Uganda Non‐Communicable Diseases and Aging Cohort (UGANDAC study ClinicalTrials.gov Identifier: NCT02445079) is a longitudinal cohort of ambulatory HIV‐infected adults stable on antiretroviral therapy (ART) for at least 3 years and matched population‐based, HIV‐uninfected controls in rural southwestern Uganda as described in detail previously …”

“…The Uganda Non-Communicable Diseases and Aging Cohort (UGANDAC study ClinicalTrials.gov Identifier: NCT02445079) is a longitudinal cohort of ambulatory HIV-infected adults stable on antiretroviral therapy (ART) for at least 3 years and matched population-based, HIV-uninfected controls in rural southwestern Uganda as described in detail previously. 14 Briefly, we first enrolled a convenience sample of HIV-infected persons aged 40 or greater receiving care at the Mbarara Regional Referral Hospital HIV clinic known as the Immune Suppression Syndrome Clinic. This is a public facility that provides free antiretroviral therapy for a largely rural population.…”

The association between HIV and atherosclerotic cardiovascular disease in sub-Saharan Africa: a systematic review

“…Although the surrogate outcomes studied are diverse and reflect discrete vascular functions, the majority of studies showed increased atherosclerosis among PLWH, either versus controls or in relation to HIV disease duration or treatment status. Although some studies demonstrate no evidence for increased atherosclerosis among PLWH [ 78 , 92 ], most studies show early subclinical atherosclerosis by surrogate CVD outcomes [ 81 , 93 – 98 ]. A large Ugandan study demonstrated subclinical atherosclerosis via cIMT in 18% of PLWH attending clinic with higher risk among ART-experienced or older patients with elevated body mass index (BMI) or LDL [ 95 ].…”

To fast or not to fast: Lipid measurement and cardiovascular disease risk estimation in rural sub-Saharan Africa

“…The study design is a longitudinal cohort study which aims to describe non-communicable disease morbidity and aging among an older, ambulatory population in rural Uganda. The cohort is comprised of two sub-groups: people over 45 years of age living with HIV (PLWH) on antiretroviral therapy (ART) in outpatient care and an age and sex-matched, HIV-uninfected, and population-based comparator group [25][26][27]. Participants are seen annually for completion of questionnaires, specimen collection, and cardiovascular diagnostic measurements.…”