To fast or not to fast: Lipid measurement and cardiovascular disease risk estimation in rural sub-Saharan Africa
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of global health
Abstract
Cardiovascular disease (CVD) morbidity and mortality are increasing
in sub-Saharan Africa (sSA), highlighting the need for tools to enable CVD
risk stratification in the region. Although non-HDL-cholesterol (nHDL-C) has
been promoted as a method to measure lipids without a requirement for fasting
in the USA, its diagnostic validity has not been assessed in sSA. We sought to
estimate: 1) the association between LDL-cholesterol (LDL-C) and nHDL-C, 2)
the impact of fasting on their measurement, and 3) their correlation with carotid
atherosclerosis, within a rural Ugandan population with high HIV prevalence.
Methods We collected traditional CVD risk factors, blood for serum lipid levels,
self-reported fasting status, and performed carotid ultrasonography in 301
participants in rural Uganda. We fit regression models, stratified by fasting status,
to estimate associations between carotid intima media thickness (cIMT),
LDL-C, and nHDL-C.
Results Median age was 50 years (interquartile range = 46-54), 49% were female,
51% were HIV-positive, and at the time of blood collection, 70% had fasted
overnight. Mean LDL-C, nHDL-C, and triglycerides in the non-fasting and
fasting groups were 85 vs 88 mg/dL (P = 0.39), 114 vs 114 mg/dL (P = 0.98),
and 130 vs 114 mg/dL (P = 0.05) mg/dL, respectively. In unadjusted models,
mean cIMT (mm) was associated with both increased LDL-C (β = 0.0078 per
10mg/dL, P < 0.01) and nHDL-C (β = 0.0075, P < 0.01), and these relationships
were similar irrespective of fasting status. After adjustment for traditional CVD
risk factors, we observed similar associations, albeit with muted effect sizes
within the fasting group.
Conclusions We found a high correlation between LDL-C and nHDL-C, and
both were correlated with cIMT, irrespective of fasting or HIV serostatus in rural
Uganda. Our findings support use of either fasting or non-fasting serum lipids
for CVD risk estimation in rural sSA.
Description
Keywords
Lipid measurement, Cardiovascular disease, Rural sub-Saharan Africa
Citation
Yang, I. T., Hemphill, L. C., Kim, J. H., Bibangambah, P., Sentongo, R., Kakuhire, B., ... & Boum, Y. (2020). To fast or not to fast: Lipid measurement and cardiovascular disease risk estimation in rural sub-Saharan Africa. Journal of global health, 10(1). doi: 10.7189/jogh.10.010407