Prevalence of cardiovascular risk factors by HIV status in a population‐based cohort in South Central Uganda: a cross‐sectional survey

Abstract

Introduction: Cardiovascular disease is one of the leading causes of mortality for people living with HIV, but limited population-based data are available from sub-Saharan Africa. This study aimed to determine the prevalence of key cardiovascular disease risk factors, 10-year risk of cardiovascular disease and type 2 diabetes mellitus through risk scores by HIV status, as well as investigate factors associated with hyperglycaemia, hypertension and dyslipidaemia in South-Central Uganda. Methods: A cross-sectional study was conducted in 37 communities of the population-based Rakai Community Cohort Study from May 2016 to May 2018. In total, 990 people living with HIV and 978 HIV-negative participants aged 35-49 years were included. Prevalence estimates and 10-year cardiovascular and type 2 diabetes risk were calculated by sex and HIV serostatus. Multivariable logistic regression was used to determine associations between socio-demographic, lifestyle and body composition risk factors and hyperglycaemia, hypertension and dyslipidaemia. Results: Overweight (21%), obesity (9%), abdominal obesity (15%), hypertension (17%) and low high-density lipoprotein (HDL) (63%) were the most common cardiovascular risk factors found in our population. These risk factors were found to be less common in people living with HIV apart from hypertension. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low in this population with <1% categorized as high risk. In HIV-adjusted multivariable analysis, obesity was associated with a higher odds of hypertension (odds ratio [OR] = 2.31, 95% confidence interval [CI] 1.35-3.96) and high triglycerides (OR = 2.08, CI 1.25-3.47), and abdominal obesity was associated with a higher odds of high triglycerides (OR = 2.55, CI 1.55-4.18) and low HDL (OR = 1.36, CI 1.09-1.71). A positive HIV status was associated with a lower odds of low HDL (OR = 0.43, CI 0.35-0.52). Conclusions: In this population-based study in Uganda, cardiovascular risk factors of obesity, abdominal obesity, hypertension and dyslipidaemia were found to be common, while hyperglycaemia was less common. Ten-year risk for cardiovascular and type 2 diabetes mellitus risk was low. The majority of cardiovascular risk factors were not affected by HIV status. The high prevalence of dyslipidaemia in our study requires further research.

Prevalence and risk factors of metabolic dysfunction‐associated steatotic liver disease in south Central Uganda: A cross‐sectional survey

“…The data source for this study has been described in detail elsewhere 19,20 . In brief, the Rakai Community Cohort Study (RCCS) is an open population‐based cohort established in 1994 by the Rakai Health Sciences Programme in South Central Uganda.…”

“…The data source for this study has been described in detail elsewhere. 19,20 fibrosis prevalence was estimated to be <1%. MASLD prevalence was more common in women (15% vs. 13%) and men (9% vs. 6%) with HIV.…”

Editorial: Enriching our understanding of MASLD through representation of under‐reported populations

“…4 In the current manuscript, authors from Karolinska University (Sweden), Rakai Health Sciences Program (Uganda) and Johns Hopkins University (USA) aimed to non-invasively determine the prevalence and risk factors of MASLD among black people between 35 and 49 years old, with and without HIV, enrolled in a recent crosssectional survey conducted between May 2016 and May 2018 at the existing Rakai Community Cohort Study (RCCS) in Uganda. 5 After excluding pregnant females and recent alcohol drinkers, MASLD prevalence was 12%, and less than 1% had advanced fibrosis (AF). MASLD prevalence was numerically, but not statistically, higher in HIV versus non-HIV people.…”

Epidemiology of obesity among people with HIV

“…In the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) study (86% male and 39% White), ART-na€ ıve adults initiating PI-based regimens had a higher risk of developing DM2 compared to those initiating NNRTI-based regimens [hazard ratio (HR) ¼ 1.27, 95% CI: 1.07-1.51] [31]. In the Rakai Community Cohort Study in South-Central Uganda (63% female), obesity was also linked to increased odds of certain cardiovascular risk factors, such as hypertension (OR ¼ 2.31, 95% CI: 1.35-3.96) among PWH [33]. With respect to other cardiovascular risk factors, in a sub-Saharan African cohort, Kaluba et al showed that PWH who were overweight had impaired vascular function, assessed through the carotid femoral augmentation index, vs. normal-weight participants after controlling for factors such as sex, age, and blood pressure [34].…”