The Haiti cardiovascular disease cohort: study protocol for a population-based longitudinal cohort

Lookens, Jean; Tymejczyk, Olga; Rouzier, Vanessa; Smith, C. Ray; Preval, Fabyola; Joseph, Inddy; Baptiste, Raynold Jean; Victor, Joscar; Sévère, Patrice; Apollon, Sandra; Dumont, Emelyne; Forestal, Guyrlaine; Preux, Stephano St; Rivera, Vanessa; Seo, Grace; Charles, Benedict; Ariste, Wilson; Kingery, Justin R; Dévieux, Jessy G.; Koenig, Serena P.; Nash, Denis; Fitzgerald, Daniel W.; Safford, Monika M.; Deschamps, Marie Marcelle; Pape, Jean William; McNairy, Margaret L.

doi:10.1186/s12889-020-09734-x

Cited by 27 publications

(43 citation statements)

References 81 publications

(47 reference statements)

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“…This analysis includes baseline cross‐sectional data from participants enrolled in the Haiti CVD Cohort Study, a longitudinal observational study of adults ≥18 years in PAP. 19 The study was conducted at the Groupe Haitien d'Etude de Sarcome de Kaposi et de Infections Opportunistes (GHESKIO), a research, treatment, and training clinic located in downtown PAP. The aims of the parent study are to estimate the prevalence and incidence of CVD risk factors and examine the role of poverty‐related social determinants.…”

Section: Methodsmentioning

confidence: 99%

Hypertension continuum of care: Blood pressure screening, diagnosis, treatment, and control in a population‐based cohort in Haiti

Metz

Pierre

Yan

et al. 2022

J of Clinical Hypertension

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Cardiovascular disease (CVD) is the number one cause of death in low‐income countries including Haiti, with hypertension (HTN) being the leading risk factor. This study aims to identify gaps in the HTN continuum of screening, diagnosis, treatment, and blood pressure (BP) control. Sociodemographic and clinical data were collected from a population‐based sample of adults ≥18 years in Port‐au‐Prince (PAP) from March 2019 to April 2021. HTN was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or use of antihypertensive medication. Screening was defined as ever having had a BP measurement; diagnosis as previously being informed of a HTN diagnosis; treatment as having taken antihypertensives in the past 2 weeks; and controlled as taking antihypertensives and having BP < 140/90 mmHg. Factors associated with attaining each step in the continuum were assessed using Poisson multivariable regressions. Among 2737 participants, 810 (29% age‐standardized) had HTN, of whom 97% had been screened, 72% diagnosed, 45% treated, and 13% controlled. There were no significant differences across age groups or sex. Obesity (BMI ≥ 30) was a significant factor associated with receiving treatment compared to normal weight (BMI < 25), with a prevalence ratio (PR) of 1.5 (95% CI 1.1–2.0). Having secondary or higher education was associated with higher likelihood of controlled BP (PR 1.9 [95% CI 1.1–3.3]). In this urban Haitian population, the greatest gaps in HTN care are treatment and control. Targeted interventions are needed to improve these steps, including broader access to affordable treatment, timely distribution of medications, and patient adherence to HTN medication.

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Section: Methodsmentioning

confidence: 99%

Hypertension continuum of care: Blood pressure screening, diagnosis, treatment, and control in a population‐based cohort in Haiti

Metz

Pierre

Yan

et al. 2022

J of Clinical Hypertension

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“…We used cross-sectional data within the Haiti CVD Cohort Study, a population-based cohort in Port-au-Prince selected using multistage random sampling with a previously described protocol (clinicaltrials.gov NCT03892265) [ 11 ]. This study has enrolled 3005 participants between March 2019 to August 2021 and follows them for 2–3.5 years to evaluate 1) the prevalence of traditional and poverty-related CVD risk factors, such as poor diet, smoking, hypertension, lead exposure, among others, and 2) the incidence of CVD events including myocardial infarction, angina, stroke, heart failure, and cardiac death.…”

Section: Methodsmentioning

confidence: 99%

Comparing six cardiovascular risk prediction models in Haiti: implications for identifying high-risk individuals for primary prevention

et al. 2022

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Background Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries (LMICs). Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention and risk factor treatment among high-risk groups. Available CVD risk prediction models are built on predominantly Caucasian risk profiles from high-income country populations, and have not been evaluated in LMIC populations. We aimed to compare six existing models for predicted 10-year risk of CVD and identify high-risk groups for targeted prevention and treatment in Haiti. Methods We used cross-sectional data within the Haiti CVD Cohort Study, including 1345 adults ≥ 40 years without known history of CVD and with complete data. Six CVD risk prediction models were compared: pooled cohort equations (PCE), adjusted PCE with updated cohorts, Framingham CVD Lipids, Framingham CVD Body Mass Index (BMI), WHO Lipids, and WHO BMI. Risk factors were measured during clinical exams. Primary outcome was continuous and categorical predicted 10-year CVD risk. Secondary outcome was statin eligibility. Results Sixty percent were female, 66.8% lived on a daily income of ≤ 1 USD, 52.9% had hypertension, 14.9% had hypercholesterolemia, 7.8% had diabetes mellitus, 4.0% were current smokers, and 2.5% had HIV. Predicted 10-year CVD risk ranged from 3.6% in adjusted PCE (IQR 1.7–8.2) to 9.6% in Framingham-BMI (IQR 4.9–18.0), and Spearman rank correlation coefficients ranged from 0.86 to 0.98. The percent of the cohort categorized as high risk using model specific thresholds ranged from 1.8% using the WHO-BMI model to 41.4% in the PCE model (χ2 = 1416, p value < 0.001). Statin eligibility also varied widely. Conclusions In the Haiti CVD Cohort, there was substantial variation in the proportion identified as high-risk and statin eligible using existing models, leading to very different treatment recommendations and public health implications depending on which prediction model is chosen. There is a need to design and validate CVD risk prediction tools for low-middle income countries that include locally relevant risk factors. Trial registration clinicaltrials.gov NCT03892265.

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Section: Methodsmentioning

confidence: 99%

Cardiovascular Disease Risk Prediction Models in Haiti: Implications for Primary Prevention in Low-Middle Income Countries

Yan

Pierre

Rouzier

et al. 2021

Preprint

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Background Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries (LMICs). Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention and risk factor treatment among high-risk groups. Available CVD risk prediction models are built on predominantly Caucasian, high-income country populations, and have not been evaluated in LMIC populations. Objective To compare the predicted 10-year risk of CVD and identify high-risk groups for targeted prevention and treatment in Haiti. Methods We used cross-sectional data within the Haiti CVD Cohort Study, including 653 adults ≥ 40 years without known history of CVD and with complete data. Six CVD risk prediction models were compared: pooled cohort equations (PCE), adjusted PCE with updated cohorts, Framingham CVD Lipids, Framingham CVD Body Mass Index (BMI), WHO Lipids, and WHO BMI. Risk factors were measured during clinical exams. Primary outcome was continuous and categorical predicted 10-year CVD risk. Secondary outcome was statin eligibility. Results Seventy percent were female, 65.5% lived on a daily income of ≤1 USD, 57.0% had hypertension, 14.5% had hypercholesterolemia, 9.3% had diabetes mellitus, 5.5% were current smokers, and 2.0% had HIV. Predicted 10-year CVD risk ranged from 3.9% in adjusted PCE (IQR 1.7-8.4) to 9.8% in Framingham-BMI (IQR 5.0-17.8), and Spearman rank correlation coefficients ranged from 0.87 to 0.98. The percent of the cohort categorized as high risk using the uniform threshold of 10-year CVD risk ≥ 7.5% ranged from 28.8% in the adjusted PCE model to 62.0% in the Framingham-BMI model (χ2 = 331, p value < 0.001). Statin eligibility also varied widely. Conclusions In the Haiti CVD Cohort, there was substantial variation in the proportion identified as high-risk and statin eligible using existing models, leading to very different treatment recommendations and public health implications depending on which prediction model is chosen. There is a need to design and validate CVD risk prediction tools for low-middle income countries that include locally relevant risk factors.

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The Haiti cardiovascular disease cohort: study protocol for a population-based longitudinal cohort

Cited by 27 publications

References 81 publications

Hypertension continuum of care: Blood pressure screening, diagnosis, treatment, and control in a population‐based cohort in Haiti

Hypertension continuum of care: Blood pressure screening, diagnosis, treatment, and control in a population‐based cohort in Haiti

Comparing six cardiovascular risk prediction models in Haiti: implications for identifying high-risk individuals for primary prevention

Cardiovascular Disease Risk Prediction Models in Haiti: Implications for Primary Prevention in Low-Middle Income Countries

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