Cardiovascular Risk Factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area analysis

Abstract Introduction Sub-Saharan Africa (SSA) is experiencing an increasing burden of Cardiovascular Diseases (CVDs). Modifiable risk factors including hypertension, diabetes, obesity, central obesity, sedentary behaviours, smoking, poor diet (characterised by inadequate vegetable and fruit consumption), and psychosocial stress are attributable to the growing burden of CVDs. Small geographical area mapping and analysis of these risk factors for CVD is lacking in most of sub-Saharan Africa and yet such data has the potential to inform monitoring and exploration of patterns of morbidity, health-care use, and mortality, as well as the epidemiology of risk factors. In the current study, we map and describe the distribution of the CVD risk factors in 20 parishes in two neighbouring districts in Uganda. Methods A baseline survey benchmarking a type-2 hybrid stepped wedge cluster randomised trial design was conducted in December 2018 and January 2019. A sample of 4372 adults aged 25-70 years was drawn from 3689 randomly selected households across 80 villages in 20 parishes in Mukono and Buikwe districts in Uganda. Descriptive statistics and generalized linear modelling controlled for clustering were conducted for this analysis in Stata 13.0, and a visual map showing risk factor distribution developed in QGIS. Results Mapping the prevalence of selected CVD risk factors indicated substantial gender and small area geographic heterogeneity. Patterns and clustering were observed for some major risk factors for CVDs including hypertension, physical inactivity, smoking, and risk factor combination. Prevalence of unhealthy diet is very high across all parishes with no significant observable difference. Conclusion Modifiable cardiovascular risk factors are common in this low income context. Moreover, across small area geographic setting, it appears significant differences in distribution of risk factors exist. These differences suggest that underlying drivers such as sociocultural, environmental and economic determinants may be promoting or inhibiting the observed risk factor prevalences which should be further explored.

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Cardiovascular Risk Factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area analysis

10.21203/rs.2.14187/v3 ◽

2020 ◽

Author(s):

Geofrey Musinguzi ◽

Rawlance Ndejjo ◽

Isaac Ssinabulya ◽

Hilde Bastiaens ◽

Harm van Marwijk ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Low Income ◽

Small Area ◽

Sub Saharan Africa ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Generalized Linear Modelling ◽

Sub Saharan

Abstract Introduction Sub-Saharan Africa (SSA) is experiencing an increasing burden of Cardiovascular Diseases (CVDs). Modifiable risk factors including hypertension, diabetes, obesity, central obesity, sedentary behaviours, smoking, poor diet (characterised by inadequate vegetable and fruit consumption), and psychosocial stress are attributable to the growing burden of CVDs. Small geographical area mapping and analysis of these risk factors for CVD is lacking in most of sub-Saharan Africa and yet such data has the potential to inform monitoring and exploration of patterns of morbidity, health-care use, and mortality, as well as the epidemiology of risk factors. In the current study, we map and describe the distribution of the CVD risk factors in 20 parishes in two neighbouring districts in Uganda. Methods A baseline survey benchmarking a type-2 hybrid stepped wedge cluster randomised trial design was conducted in December 2018 and January 2019. A sample of 4372 adults aged 25-70 years was drawn from 3689 randomly selected households across 80 villages in 20 parishes in Mukono and Buikwe districts in Uganda. Descriptive statistics and generalized linear modelling controlled for clustering were conducted for this analysis in Stata 13.0, and a visual map showing risk factor distribution developed in QGIS. Results Mapping the prevalence of selected CVD risk factors indicated substantial gender and small area geographic heterogeneity. Patterns and clustering were observed for some major risk factors for CVDs including hypertension, physical inactivity, smoking, and risk factor combination. Prevalence of unhealthy diet was very high across all parishes with no significant observable differences across areas. Conclusion Modifiable cardiovascular risk factors are common in this low income context. Moreover, across small area geographic setting, it appears significant differences in distribution of risk factors exist. These differences suggest that underlying drivers such as sociocultural, environmental and economic determinants may be promoting or inhibiting the observed risk factor prevalences which should be further explored.

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Cardiovascular Risk Factor mapping and distribution among adults in Mukono and Buikwe districts in Uganda: small area analysis

10.21203/rs.2.14187/v2 ◽

2020 ◽

Author(s):

Geofrey Musinguzi ◽

Rawlance Ndejjo ◽

Isaac Ssinabulya ◽

Hilde Bastiaens ◽

Harm van Marwijk ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Low Income ◽

Small Area ◽

Sub Saharan Africa ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Generalized Linear Modelling ◽

Sub Saharan

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Estimating the burden of cardiovascular risk in community dwellers over 40 years old in South Africa, Kenya, Burkina Faso and Ghana

BMJ Global Health ◽

10.1136/bmjgh-2020-003499 ◽

2021 ◽

Vol 6 (1) ◽

pp. e003499

Author(s):

Ryan G Wagner ◽

Nigel J Crowther ◽

Lisa K Micklesfield ◽

Palwende Romauld Boua ◽

Engelbert A Nonterah ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

South African ◽

Sub Saharan Africa ◽

African Countries ◽

Cvd Risk ◽

Genomic Studies ◽

Sub Saharan ◽

Context Specific ◽

The Impact

IntroductionCardiovascular disease (CVD) risk factors are increasing in sub-Saharan Africa. The impact of these risk factors on future CVD outcomes and burden is poorly understood. We examined the magnitude of modifiable risk factors, estimated future CVD risk and compared results between three commonly used 10-year CVD risk factor algorithms and their variants in four African countries.MethodsIn the Africa-Wits-INDEPTH partnership for Genomic studies (the AWI-Gen Study), 10 349 randomly sampled individuals aged 40–60 years from six sites participated in a survey, with blood pressure, blood glucose and lipid levels measured. Using these data, 10-year CVD risk estimates using Framingham, Globorisk and WHO-CVD and their office-based variants were generated. Differences in future CVD risk and results by algorithm are described using kappa and coefficients to examine agreement and correlations, respectively.ResultsThe 10-year CVD risk across all participants in all sites varied from 2.6% (95% CI: 1.6% to 4.1%) using the WHO-CVD lab algorithm to 6.5% (95% CI: 3.7% to 11.4%) using the Framingham office algorithm, with substantial differences in risk between sites. The highest risk was in South African settings (in urban Soweto: 8.9% (IQR: 5.3–15.3)). Agreement between algorithms was low to moderate (kappa from 0.03 to 0.55) and correlations ranged between 0.28 and 0.70. Depending on the algorithm used, those at high risk (defined as risk of 10-year CVD event >20%) who were under treatment for a modifiable risk factor ranged from 19.2% to 33.9%, with substantial variation by both sex and site.ConclusionThe African sites in this study are at different stages of an ongoing epidemiological transition as evidenced by both risk factor levels and estimated 10-year CVD risk. There is low correlation and disparate levels of population risk, predicted by different risk algorithms, within sites. Validating existing risk algorithms or designing context-specific 10-year CVD risk algorithms is essential for accurately defining population risk and targeting national policies and individual CVD treatment on the African continent.

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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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Cardiometabolic Risk Factors and Preclinical Target Organ Damage Among Adults in Ghana: Findings From a National Study

Journal of the American Heart Association ◽

10.1161/jaha.120.017492 ◽

2020 ◽

Vol 9 (24) ◽

Author(s):

Jie Li ◽

Isaac Kofi Owusu ◽

Qingshan Geng ◽

Aba Ankomaba Folson ◽

Zhichao Zheng ◽

...

Keyword(s):

Risk Factors ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Sub Saharan Africa ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Sub Saharan ◽

Artery Disease

Background Although sub‐Saharan Africa has a high prevalence of cardiovascular diseases (CVDs), there remains a lack of systematic and comprehensive assessment of risk factors and early CVD outcomes in adults in sub‐Saharan Africa. Methods and Results Using a stratified multistage random sampling method, we recruited 1106 men and women, aged >18 years, from the general population in Ghana to participate in a national health survey from 2016 to 2017. In Ghanaian adults, the age‐standardized prevalence of known CVD risk factors was 15.1% (95% CI, 12.9%–17.3%) for obesity, 6.8% (95% CI, 5.1%–8.5%) for diabetes mellitus, 26.1% (95% CI, 22.9%–29.4%) for hypertension, and 9.3% (95% CI, 7.1%–11.5%) for hyperuricemia. In addition, 10.1% (95% CI, 7.0%–13.2%) of adults had peripheral artery disease, 8.3% (95% CI, 6.7%–10.0%) had carotid thickening, 4.1% (95% CI, 2.9%–5.2%) had left ventricular hypertrophy, and 2.5% (95% CI, 1.5%–3.4%) had chronic kidney disease. Three CVD risk factors appeared to play prominent roles in the development of target organ damage, including obesity for peripheral artery disease (odds ratio [OR], 2.22; 95% CI, 1.35–3.63), hypertension for carotid thickening (OR, 1.92; 95% CI, 1.22–3.08), and left ventricular hypertrophy (OR, 5.28; 95% CI, 2.55–12.11) and hyperuricemia for chronic kidney disease (OR, 5.49; 95% CI, 2.84–10.65). Conclusions This comprehensive health survey characterized the baseline conditions of a national cohort of adults while confirming the prevalence of CVD risk factors, and early CVD outcomes have reached epidemic proportions in Ghana. The distinct patterns of risk factors in the development of target organ damage present important challenges and opportunities for interventions to improve cardiometabolic health among adults in Ghana.

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P6362Impact of the 2017 AHA/ACC hypertension guideline on hypertension prevalence and cardiovascular risk factors in a healthy older cohort

European Heart Journal ◽

10.1093/eurheartj/ehz746.0958 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

E K Chowdhury ◽

M R Nelson ◽

M E Ernst ◽

K L Margolis ◽

L J Beilin ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Risk Factor ◽

Cardiovascular Risk ◽

Disease Risk ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Hypertension Prevalence ◽

Hypertension Guideline ◽

Healthy Elderly

Abstract Background The 2017 American Heart Association (AHA)/American College of Cardiology (ACC) hypertension guideline recommends a target blood pressure (BP) of <130/80 mmHg regardless of age, which is lower than previously recommended BP goals. Purpose We aimed to determine how much the updated classification for high BP would increase the overall prevalence of “hypertension” in an otherwise healthy elderly population. Additionally, we explored the cardiovascular disease (CVD) risk factor distribution in those newly classified “hypertensives” to determine whether the increased prevalence of hypertension was accompanied by an increase in other modifiable CVD risk factors. Methods We used baseline data from 19,114 participants (16,703 in Australia and 2,411 in the USA) aged ≥65 years who were enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) study between 2010 and 2014. Participants were classified as having hypertension using either: (a) pre-2017 thresholds (SBP ≥140 mmHg or mean DBP ≥90 mmHg and/or on anti-hypertensive) or (b) 2017 AHA/ACC guidelines (SBP ≥130 mmHg or DBP ≥80 mmHg and/or on anti-hypertensive). We assessed the presence of cardiovascular disease risk factors such as diabetes, hypercholesterolemia, smoking, obesity, reduced renal function among these hypertensive participants and also estimated their predicted risk over 10 years. Results Based on pre-2017 thresholds, 74% of the participants met the criteria for hypertension. Hypertension prevalence increased to 87% when the more stringent 2017 guideline was applied. 29% of this subset of newly classified hypertensive participants did not have any other identifiable traditional CVD risk factors. Further, a significantly lower 10-year predicted cardiovascular risk (22% versus 26%, p<0.001) among those newly classified hypertensive participants was observed in relation to those having hypertension based on pre-2017 guideline (Figure 1). Figure 1. 10-year predicted CVD risk among hyoertensive and newly classified hypertensive ASPREE participants by presence of CVD risk factor Conclusion As expected, the prevalence of hypertension increased among the healthy elderly when applying the new AHA-2017 guideline; however, the increased prevalence occurs despite lack of an accompanying increase in additional CVD risk factors or predicted 10-year risk. Our findings suggest an individualized approach is needed in evaluating high BP among the healthy elderly. Acknowledgement/Funding National Institute on Aging and the National Cancer Institute at NIH; NHMRC Australia, Monash University, Victorian Cancer Agency (Australia)

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Cardiovascular risk factors and disease among non-European immigrants living in Catalonia

Heart ◽

10.1136/heartjnl-2018-314436 ◽

2019 ◽

pp. heartjnl-2018-314436

Author(s):

Miguel Cainzos-Achirica ◽

Emili Vela ◽

Montse Cleries ◽

Usama Bilal ◽

Josepa Mauri ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Universal Access ◽

South Asians ◽

Local Population ◽

Sub Saharan Africa ◽

Cvd Risk ◽

Sub Saharan

ObjectiveTo describe the prevalence and incidence of cardiovascular risk factors, established cardiovascular disease (CVD) and cardiovascular medication use, among immigrant individuals of diverse national origins living in Catalonia (Spain), a region receiving large groups of immigrants from all around the world, and with universal access to healthcare.MethodsWe conducted a population-based analysis including >6 million adult individuals living in Catalonia, using the local administrative healthcare databases. Immigrants were classified in 6 World Bank geographic areas: Latin America/Caribbean, North Africa/Middle East, sub-Saharan Africa, East Asia and South Asia. Prevalence calculations were set as of 31 December 2017.ResultsImmigrant groups were younger than the local population; despite this, the prevalence of CVD risk factors and of established CVD was very high in some immigrant subgroups compared with local individuals. South Asians had the highest prevalence of diabetes, and of hyperlipidemia among adults aged <55 years; hypertension was highly prevalent among sub-Saharan Africans, and obesity was most common among women of African and South Asian ancestry. In this context, South Asians had the highest prevalence of coronary heart disease across all groups, and of heart failure among women. Heart failure was also highly prevalent in African women.ConclusionsThe high prevalence of risk factors and established CVD among South Asians and sub-Saharan Africans stresses the need for tailored, aggressive health promotion interventions. These are likely to be beneficial in Catalonia, and in countries receiving similar migratory fluxes, as well as in their countries of origin.

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Geographic Disparities in Cardiovascular Death Among Patients with Myelodysplastic Syndromes

Blood ◽

10.1182/blood-2021-146683 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 3060-3060

Author(s):

Diego Adrianzen Herrera ◽

Andrew D Sparks ◽

Neil A. Zakai ◽

Benjamin Littenberg

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Rural Areas ◽

Cardiovascular Death ◽

Rural Residence ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Geographic Disparities ◽

Race Ethnicity

Abstract Introduction: Acquired somatic mutations in hematopoietic stem cells lead to myelodysplastic syndromes (MDS) and are also associated with accelerated atherosclerosis. In subjects without MDS, these mutations constitute a potent cardiovascular risk factor: clonal hematopoiesis (CH). In a previous analysis, we demonstrated that an MDS diagnosis was an independent risk factor for cardiovascular disease (CVD) compared to propensity matched non-cancer controls. CVD is the most common non-cancer cause of death in MDS, and rural residence has been independently associated with many CVD risk factors. However, there are no studies examining the association of geographic disparities and cardiovascular death in patients with MDS. Methods: We identified adult patients diagnosed with MDS between 2001 and 2016 using the Surveillance, Epidemiology, and End Results (SEER) database. MDS risk was classified as low, intermediate or high, using International Classification of Diseases for Oncology 3 rd Edition (ICDO-3) codes. Rural and urban populations were categorized using the US Department of Agriculture's Rural-Urban Continuum Codes (RUCC). Primary cause of death reported to State Registries (SEER COD recode) was used to estimate cause-specific survival, calculated from date of MDS diagnosis to date of CVD-related death. Cases with missing data on any key variable were excluded from analysis. SEER*Stat version 8.3.9 was used to calculate incidence rates. Chi-square and t-test were used to compare categorical and continuous variables, respectively. Survival analyses employed the Kaplan-Meier method and log-rank tests. Multivariable Cox-proportional hazards repression estimated the association of rural residence with CVD death adjusting for age, sex, race, ethnicity, MDS risk, and geographic location. SAS version 9.4 was used for statistical analysis. Results: We included 52,750 patients with MDS, 56.8% were male and 84.8% were white. Low, intermediate and high histologic risk were seen in 18.7%, 64.4% and 16.9% respectively. Most patients were from urban areas (88%), however the estimated incidence rate for MDS was 6.7 per 100,000 per population at risk in both urban and rural populations. The rural MDS population was younger (median age 75 vs 77 years, p<0.004) and had a higher proportion of whites (90.5% vs 84%, p<0.001), but no difference in MDS risk distribution was noted by rurality (Table 1). Unadjusted analyses revealed a trend towards lower overall survival in the rural MDS population (24 vs 25 months, p=0.051). After adjusting for age, sex, race, ethnicity, MDS risk and area of residence, rural subjects with MDS had a 12% increased hazard (HR 1.12, 95%CI 1.03 - 1.22) for CVD-related death compared to urban subjects (Figure 1). Further, the adjusted HR for CVD-related death was 1.23 (CI95% 1.01 - 1.50) for those who lived in the most rural areas (RUCC codes 8 and 9, less than 2,500 urban population). Among young MDS patients (age<65), those residing in rural areas had a higher proportion of CVD-related death (6% vs 4.7%, p=0.031) and significantly shorter CVD-specific survival compared to urban patients (Figure 2). MDS histologic risk was also a significant factor in the multivariable model (Table 2). Compared to low risk MDS, patients with intermediate and high risk had adjusted HR for CVD-related death of 1.17 (95%CI 1.11 - 1.24) and 1.2 (95%CI 1.09 - 1.32), respectively. Other factors significantly associated with increased hazard for CVD-related death in the adjusted model were advancing age and male sex. Discussion: In a large population-based study, we found that rural area of residence is significantly associated with a higher burden of CVD-related death in subjects with MDS, after adjusting for demographic risk factors and MDS risk classification. Although aging is an important issue in rural areas, the geographical disparities in CVD-related death among MDS patients are not explained by age alone and the difference was notable in young MDS patients. These findings should prompt hematologists caring for patients with MDS from rural areas to rigorously evaluate and address CVD risk factors. As novel treatments improve cancer-specific survival in MDS, marginalized populations with different CVD risk profiles may be disproportionally affected by the cardiovascular risk from CH, which should be considered when developing MDS surveillance programs. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Contrasting Monetary and Multidimensional Poverty Measures in a Low-Income Sub-Saharan African Country

Social Indicators Research ◽

10.1007/s11205-020-02382-z ◽

2020 ◽

Vol 151 (2) ◽

pp. 547-574 ◽

Cited By ~ 1

Author(s):

Lukas Salecker ◽

Anar K. Ahmadov ◽

Leyla Karimli

Keyword(s):

Risk Factors ◽

Low Income ◽

Multidimensional Poverty ◽

Poverty Measurement ◽

Sub Saharan Africa ◽

Analytical Strategy ◽

Poverty Risk ◽

Two Measures ◽

Sub Saharan ◽

Over Time

AbstractDespite significant progress in poverty measurement, few studies have undertaken an in-depth comparison of monetary and multidimensional measures in the context of low-income countries and fewer still in Sub-Saharan Africa. Yet the differences can be particularly consequential in these settings. We address this gap by applying a distinct analytical strategy to the case of Rwanda. Using data from two waves of the Rwandan Integrated Household Living Conditions Survey, we combine comparing poverty rates cross-sectionally and over time, examining the overlaps and differences in the two measures, investigating poverty rates within population sub-groups, and estimating several statistical models to assess the differences between the two measures in identifying poverty risk factors. We find that using a monetary measure alone does not capture high incidence of multidimensional poverty in both waves, that it is possible to be multidimensional poor without being monetary poor, and that using a monetary measure alone overlooks significant change in multidimensional poverty over time. The two measures also differ in which poverty risk factors they put emphasis on. Relying only on monetary measures in low-income sub-Saharan Africa can send inaccurate signals to policymakers regarding the optimal design of social policies as well as monitoring their effectiveness.

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Abstract P400: The Association Between Cross-sex Hormone Therapy and Cardiovascular Disease Risk Factors Among Male-to-female Transgender Persons in Chiang Mai, Thailand

Circulation ◽

10.1161/circ.141.suppl_1.p400 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Rebecca L Molinsky ◽

Kanokwan Kulprachakarn ◽

Sakaewan Ounjaijean ◽

Ryan Demmer ◽

Kittipan Rerkasem

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Risk Factor ◽

Hormone Therapy ◽

Sex Hormone ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Transgender Persons ◽

The Relationship ◽

Male To Female

Background: Cross-sex hormone therapy (CSHT) is prescribed to transition secondary sexual characteristics among individuals undergoing male-to-female (MtF) transitions (age range 18-41, mean age=24). Limited data exist to inform the cardiovascular disease (CVD) risk factor profile associated with CSHT. We investigated the relationship between CSHT and cardiovascular risk factors in MtF transgender persons and hypothesize that CSHT will be associated with adverse CVD risk factor profiles. Methods: A cross-sectional study was conducted from October 1 st , 2018 to November 30 th , 2018 in 100 MtF transgender people not receiving CSHT vs. 100 receiving CSHT. CSHT use was defined by self-report use of up to 23 medications. Serum testosterone and 17-beta estradiol were assessed to validate CSHT use. Systolic and diastolic blood pressure was measured. Lipid profiles, fasting plasma glucose (FPG), C-reactive protein, cardiac troponin I and pro b-type natriuretic peptide (proBNP) were assessed from fasting blood. Non-invasive arterial examinations included: carotid intima-media thickness (CIMT), ankle-brachial index (ABI), cardio-ankle vascular index (CAVI), and pulse wave velocity (PWV). Multivariable linear regression models, regressed CVD risk factors on CSHT status. Among the subgroup of CSHT users, we assessed the relationship between duration of use and CVD risk factors. Multivariable models included age, gender, education, income, drinking, smoking, exercise, and BMI. Results: Participant mean age was 24±0.38 years and did not differ by CSHT use. Mean±SE values of testosterone were in the CSHT vs. control group were 4.8±0.3 vs. 5.8±0.3 ng/ml, p=0.06 and 17-beta estradiol levels were 45.6±14.9 vs. 34.7±14.8, p=0.7). CIMT was modestly lower among CSHT vs. controls (0.35±0.01 vs. 0.38±0.01, p=0.09). The average duration of CSHT use was 6.65±0.522 years. Among CSHT users, for every 1-year increase in duration of CSHT use total cholesterol decreased by -2.360 ± 1.096, p=0.0341 mg/dL, LDL-cholesterol decreased by -3.076 ± 1.182, p=0.0109 mg/dL, ABI decreased by -0.006 ± 0.002, p=0.0087 while FPG increased by 2.558 ± 0.899 mg/dL, p=0.0055. Conclusion: Among MtF transgender persons, using CSHT was not associated with increased CVD risk factors levels.

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