Comparison of different cardiovascular risk tools used in HIV patient cohorts in sub-Saharan Africa; do we need to include laboratory tests?

Introduction Cardiovascular disease (CVD) is the leading cause of death globally, representing 31% of all global deaths. HIV and long term anti-retroviral therapy (ART) are risk factors for development of CVD in populations of people living with HIV (PLHIV). CVD risk assessment tools are currently being applied to SSA populations, but there are questions about accuracy as well as implementation challenges of these tools in lower resource setting populations. We aimed to assess the level of agreement between the various cardiovascular screening tools (Data collection on Adverse effects of anti-HIV Drugs (D:A:D), Framingham risk score, WHO risk score and The Atherosclerotic Cardiovascular Disease Score) when applied to an HIV ART experienced population in Sub-Saharan Africa. Methods This study was undertaken in an Anti-Retroviral Long Term (ALT) Cohort of 1000 PLHIV in care who have been on ART for at least 10 years in urban Uganda. A systematic review was undertaken to find the most frequently used screening tools from SSA PLHIV populations; these were applied to the ALT cohort. Levels of agreement between the resulting scores (those including lipids and non-lipids based, as well as HIV-specific and non-HIV specific) as applied to our cohort were compared. Prevalence Bias Adjusted Kappa was used to evaluate agreement between tools. Results Overall, PLHIV in ALT cohort had a median score of 1.1–1.4% risk of a CVD event over 5 years and 1.7–2.5% risk of a CVD event over 10 years. There was no statistical difference in the risk scores obtained for this population when comparing the different tools, including comparisons of those with lipids and non-lipids, and HIV specific vs non-HIV specific. Conclusion The various tools yielded similar results, but those not including lipids are more feasible to apply in our setting. Long-term cohorts of PLHIV in SSA should in future provide longitudinal data to evaluate existing CVD risk prediction tools for these populations. Inclusion of HIV and ART history factors to existing scoring systems may improve accuracy without adding the expense and technical difficulty of lipid testing.

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Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework

Journal of Aging and Health ◽

10.1177/0898264317724549 ◽

2017 ◽

Vol 31 (1) ◽

pp. 109-138 ◽

Cited By ~ 10

Author(s):

Mark J. Siedner

Keyword(s):

Quality Of Life ◽

Conceptual Framework ◽

Care Delivery ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

Sub Saharan ◽

Living With Hiv ◽

The Impact

Objective: The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. Methods: A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. Results: We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. Conclusions: Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.

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Cardiovascular Disease Healthcare Utilization in Sub-Saharan Africa: A Scoping Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16030419 ◽

2019 ◽

Vol 16 (3) ◽

pp. 419 ◽

Cited By ~ 3

Author(s):

Herbert Chikafu ◽

Moses Chimbari

Keyword(s):

Cardiovascular Disease ◽

Healthcare Utilization ◽

Hospital Admissions ◽

Stroke Care ◽

Sub Saharan Africa ◽

Quantitative Methodology ◽

Healthcare Provision ◽

Cvd Risk ◽

Epidemiological Transitions ◽

Sub Saharan

Sub-Saharan African (SSA) countries face a growing burden of cardiovascular disease (CVD), attributed to economic, nutritional, demographic, and epidemiological transitions. These factors increase the prevalence of CVD risk factors, and the CVD burden overlaps with a high prevalence of infectious diseases. This review aimed to understand CVD healthcare utilization determinants and levels in SSA. We conducted a systematic search of the literature on major databases for the period 2008–2018 using exhaustive combinations of CVD and utilization indicators as search terms. Eighteen studies from eight countries were included in this review. Most studies (88.8%) followed the quantitative methodology and largely focused on inpatient stroke care. Two-thirds of patients sought care within 24 h of suffering a stroke, and the length of stay (LOS) in hospital ranged between 6 and 81 days. Results showed a rising trend of CVD admissions within total hospital admissions. Coverage of physiotherapy services was limited and varied between countries. While few studies included rural populations, utilization was found to be negatively associated with rural residence and socioeconomic status. There is a need to extend healthcare provision in SSA to ensure access to the CVD continuum of care.

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Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of Seven Communities in East and West Africa (SevenCEWA)

10.21203/rs.3.rs-25100/v4 ◽

2020 ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

Abstract Background: Few studies have characterized epidemiology and management of hypertension across several communities with comparable methodology in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. Methods: Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. We collected data on socio-demographics, health insurance, and healthcare utilization. We measured blood pressure using digital blood pressure monitors and following a standardized protocol. We estimated 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness and treatment. Results: We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked, and 32·7% were overweight/obese. A quarter of the participants (25·1% had hypertension, half of whom (57·6%) were diagnosed. Among diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% Interquartile range, IQR (2·4%, 10·3%) and 13·2% had risk of 20% or greater while 7·1% had risk of >30%. Conclusion: In seven communities in east and west Africa, a quarter of adults had hypertension, about 40% were unaware, half of those aware were treated and half of those treated were controlled blood pressure. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

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COVID-19 and its effects on endothelium in HIV-positive patients in sub-Saharan Africa: Cardiometabolic risk, thrombosis and vascular function (ENDOCOVID STUDY)

BMC Infectious Diseases ◽

10.1186/s12879-021-06426-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nandu Goswami ◽

Per Morten Fredriksen ◽

Knut E. A. Lundin ◽

Chidozie Agu ◽

Simiat Olanike Elias ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Endothelial Function ◽

Hiv Infection ◽

Sub Saharan Africa ◽

System Capacity ◽

People Living With Hiv ◽

Vascular Endothelial ◽

Vascular Endothelial Function ◽

Sub Saharan

Abstract Background COVID-19 has affected almost every country in the world, especially in terms of health system capacity and economic burden. People from sub-Saharan Africa (SSA) often face interaction between human immunodeficiency virus (HIV) infection and non-communicable diseases such as cardiovascular disease. Role of HIV infection and anti-retroviral treatment (ART) in altered cardiovascular risk is questionable and there is still need to further carry out research in this field. However, thus far it is unclear, what impact the COVID-19 co-infection in people living with HIV (PLHIV), with or without therapy will have. The ENDOCOVID project aims to investigate whether and how HIV-infection in COVID-19 patients modulates the time course of the disease, alters cardiovascular risk, and changes vascular endothelial function and coagulation parameters/ thrombosis risk. Methods A total of 1026 patients will be included into this study. Cardiovascular research PLHIV with (n = 114 in each of the three recruiting centers) - or without - ART (n = 114 in each of the three recruiting centers) with COVID-19 and HIV-negative with COVID-19 (n = 114 in each of the three recruiting centers) will be carried out via clinical and biochemical measurements for cardiovascular risk factors and biomarkers of cardiovascular disease (CVD). Vascular and endothelial function will be measured by brachial artery flow-mediated dilatation (FMD), carotid intima-media thickness (IMT) assessments, and retinal blood vessel analyses, along with vascular endothelial biomarkers and cogualation markers. The correlation between HIV-infection in COVID-19 PLHIV with or without ART and its role in enhancement of cardiovascular risk and endothelial dysfunction will be assessed at admission, weekly, at discharge and, 4 weeks post-discharge (if possible). Impact of project The ENDOCOVID project aims to evaluate in the long-term the cardiovascular risk and vascular endothelial function in PLHIV thus revealing an important transitional cardiovascular phenotype in COVID-19. The study was registered under clinicaltrials.gov (NCT04709302).

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Red Cell Distribution Width Is Positively Correlated with Atherosclerotic Cardiovascular Disease 10-Year Risk Score, Age, and CRP in Spondyloarthritis with Axial or Peripheral Disease

International Journal of Rheumatology ◽

10.1155/2018/2476239 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Hassan Ahmad ◽

Mariam Khan ◽

Michelle Laugle ◽

Desmond A. Jackson ◽

Christopher Burant ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Score ◽

Smoking Status ◽

Cardiac Conduction ◽

Atherosclerotic Cardiovascular Disease ◽

Cell Distribution ◽

Cvd Risk ◽

Hypertension Status ◽

Distribution Width ◽

Hemoglobin C

Background. Red blood cell distribution width (RDW) is a routine hematologic parameter that is a predictor of cardiovascular disease (CVD) events and is independent of combined traditional risk factor scoring systems. The RDW has also been associated with rheumatic disease activity. Whether RDW is associated with traditional CVD risk factors or Atherosclerotic Cardiovascular Disease (ASCVD) 10-year CVD risk score in patients with seronegative spondyloarthritis with axial or peripheral disease has not been previously determined. Methods. We performed a retrospective, chart review study evaluating the relationship between RDW, albumin, hemoglobin, C-reactive protein (CRP), absolute lymphocyte count (ALC), and ASCVD scoring parameters [age, hypertension status, diabetes mellitus (DM) status, lipid profile, and smoking status] in a cohort of spondyloarthritis patients, taking into consideration their HLA-B27 status, race, and treatment status. Results. RDW was found to positively correlate with ASCVD 10-year score and age, and ASCVD score did not change over time after patients were treated for spondyloarthritis. Albumin was found to negatively correlate with ASCVD 10-year risk score. Both RDW and albumin correlated with CRP. ALC failed to correlate with ASCVD 10-year score but did show a tendency to be associated with CVD, CVD events, and cardiac conduction abnormalities. Conclusions. These data indicate that further study is warranted to evaluate RDW, albumin level, and ALC as potential predictors of CVD in the spondyloarthritis patient population.

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

BMC Public Health ◽

10.1186/s12889-017-4940-1 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 15

Author(s):

Emily P. Hyle ◽

Bongani M. Mayosi ◽

Keren Middelkoop ◽

Mosepele Mosepele ◽

Emily B. Martey ◽

...

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Sub Saharan Africa ◽

Atherosclerotic Cardiovascular Disease ◽

Sub Saharan

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Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of seven communities in East and West Africa (SevenCEWA)

BMC Public Health ◽

10.1186/s12889-020-09829-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Samson Okello ◽

Alfa Muhihi ◽

Shukri F. Mohamed ◽

Soter Ameh ◽

Caleb Ochimana ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Health Insurance ◽

West Africa ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Hypertension Prevalence ◽

East And West ◽

Sub Saharan ◽

And Control

Abstract Background Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. Methods Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness, and treatment. Results We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4%) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% (Interquartile range (IQR), 2·4%, 10·3%) and 13·2% had predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of > 30%. Conclusion In seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.

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Cardiovascular disease: the new epidemic in sub-Saharan Africa

Vascular ◽

10.1258/vasc.2011.ra0049 ◽

2011 ◽

Vol 19 (6) ◽

pp. 301-307 ◽

Cited By ~ 16

Author(s):

Ifechukwude Ikem ◽

Bauer E Sumpio

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Sub Saharan Africa ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Double Burden ◽

The Usa ◽

Acquired Immunodeficiency ◽

Sub Saharan ◽

Immunodeficiency Syndrome

Sub-Saharan Africa (SSA) is now facing a double burden of disease where patients are suffering from non-communicable diseases such as coronary heart disease, along with the burden of the current human immunodeficiency virus (HIV) epidemic. Due to this double burden, cardiovascular disease (CVD) prevention and treatment has been overlooked, allowing the rates to continue to rise unchecked. A series of searches were conducted using PubMed as the primary database. From these searches, journal articles were compiled that related to diabetes, obesity and smoking rates in SSA. Also, the prevalence of CVD in the USA was reviewed. Although the USA has higher rates of CVD now, the rates were on the decline compared with SSA. Due to ‘Westernization’ of SSA, the rates of CVD risk factors, such as diabetes, are expected to increase by 50%. Because of this, 80% of CVD deaths worldwide took place in developing countries like those in SSA. Although HIV/acquired immunodeficiency syndrome (AIDS) is the current epidemic in SSA, CVD disease poses a threat as the new epidemic because of the increasing rates of these CVD risk factors. Without combating this disease now, SSA is facing an epidemiological shift from AIDS to CVD being the leading cause of death.

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