Cardiovascular risk factors and markers of myocardial injury and inflammation in people living with HIV in Nairobi, Kenya: a pilot cross-sectional study

• Type of Material: Article
• Authors: Hassan Adan Ahmed, Aga Khan University; Jeilan Mohamed, Aga Khan University; Isaiah G. Akuku, University of Nairobi; Kuan Ken Lee, University of Edinburgh; Shirjel R. Alam, London School of Hygiene & Tropical Medicine; Pablo Perel, London School of Hygiene & Tropical Medicine; Jasmit Shah, Aga Khan University; Mohammed Ali, Emory University; Sherry Eskander, Coptic Hospital; Michael Chung, Emory University; Anoop S.V. Shah, London School of Hygiene & Tropical Medicine
• Language: English
• Date: 2022-06-01
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2022
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjopen-2022-062352
• Title of Journal or Parent Work: BMJ OPEN
• Volume: 12
• Issue: 6
• Start Page: e062352
• End Page: e062352
• Grant/Funding Information: Supported by the Global Challenges Research Fund UKRI and the British Heart Foundation Intermediate Clinical Research Fellowship.
• Keywords: GLOBAL BURDEN; SYSTEMATIC ANALYSIS; ASSOCIATION; Science & Technology; HIV & AIDS; MORTALITY; ANTIRETROVIRAL THERAPY; Life Sciences & Biomedicine; Adult cardiology; TROPONIN; PRIMARY PREVENTION; General & Internal Medicine; C-REACTIVE PROTEIN; PREVALENCE; DISEASE; EPIDEMIOLOGY; Medicine, General & Internal
• Research Categories: Biology, Virology; Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Objectives To determine the prevalence of cardiovascular disease (CVD) risk factors and explore associations with high-sensitivity cardiac troponin I (hscTnI) and high-sensitivity C-reactive protein (hsCRP) in people living with HIV (PLHIV) in Kenya. Design Pilot cross-sectional study. Setting Data were collected from community HIV clinics across two sites in Nairobi, Kenya, from July 2019 to May 2020. Participants Convenience sample of 200 PLHIV (≥30 years with no prior history of CVD). Outcome measures Prevalence of cardiovascular risk factors and its association with hsTnI and hsCRP levels. Results Across 200 PLHIV (median age 46 years, IQR 38-53; 61% women), the prevalence of hypercholesterolaemia (total cholesterol >6.1 mmol/L) and hypertension were 19% (n=30/199) and 30% (n=60/200), respectively. Smoking and diabetes prevalence was 3% (n=5/200) and 4% (n=7/200). HscTnI was below the limit of quantification (<2.5 ng/L) in 65% (n=109/169). High (>3 mg/L), intermediate (1-3 mg/L) and low (<1 mg/L) hsCRP levels were found in 38% (n=75/198), 33% (n=65/198) and 29% (n=58/198), respectively. Framingham laboratory-based risk scores classified 83% of PLHIV at low risk with 12% and 5% at intermediate and high risk, respectively. Older age (adjusted OR (aOR) per year increase 1.05, 95% CI 1.01 to 1.08) and systolic blood pressure (140-159 mm Hg (aOR 2.96; 95% CI 1.09 to 7.90) and >160 mm Hg (aOR 4.68, 95% CI 1.55 to 14) compared with <140 mm Hg) were associated with hscTnI levels. No associations were observed between hsCRP and CVD risk factors. Conclusion The majority of PLHIV - using traditional risk estimation systems - have a low estimated CVD risk likely reflecting a younger aged population predominantly consisting of women. Hypertension and hypercholesterolaemia were common while smoking and diabetes rates remained low. While hscTnI values were associated with increasing age and raised blood pressure, no associations between hsCRP levels and traditional cardiovascular risk factors were observed.