Ideal Cardiovascular Health and Carotid Atherosclerosis in a Mixed Cohort of HIV-Infected and Uninfected Ugandans
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
AIDS research and human retroviruses
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 0.024mm 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.
Description
Keywords
Human immunodeficiency virus, Cardiovascular disease, Ideal cardiovascular health, Epidemiology, Primary prevention, Risk factors
Citation
Feinstein, M. J., Kim, J. H., Bibangambah, P., Sentongo, R., Martin, J. N., Tsai, A. C., ... & Siedner, M. J. (2017). Ideal cardiovascular health and carotid atherosclerosis in a mixed cohort of HIV-infected and uninfected Ugandans. AIDS research and human retroviruses, 33(1), 49-56. DOI: 10.1089/aid.2016.0104