Cardiometabolic risk in a population of older adults with multiple co-morbidities in rural south africa: the HAALSI (Health and Aging in Africa: longitudinal studies of INDEPTH communities) study

Abstract

BackgroundA consequence of the widespread uptake of anti-retroviral therapy (ART) is that the older South African population will experience an increase in life expectancy, increasing their risk for cardiometabolic diseases (CMD), and its risk factors. The long-term interactions between HIV infection, treatment, and CMD remain to be elucidated in the African population. The HAALSI cohort was established to investigate the impact of these interactions on CMD morbidity and mortality among middle-aged and older adults.MethodsWe recruited randomly selected adults aged 40 or older residing in the rural Agincourt sub-district in Mpumalanga Province. In-person interviews were conducted to collect baseline household and socioeconomic data, self-reported health, anthropometric measures, blood pressure, high-sensitivity C-reactive protein (hsCRP), HbA1c, HIV-status, and point-of-care glucose and lipid levels.ResultsFive thousand fifty nine persons (46.4% male) were enrolled with a mean age of 61.7 ± 13.06 years. Waist-to-hip ratio was high for men and women (0.92 ± 0.08 vs. 0.89 ± 0.08), with 70% of women and 44% of men being overweight or obese. Blood pressure was similar for men and women with a combined hypertension prevalence of 58.4% and statistically significant increases were observed with increasing age. High total cholesterol prevalence in women was twice that observed for men (8.5 vs. 4.1%). The prevalence of self-reported CMD conditions was higher among women, except for myocardial infarction, and women had a statistically significantly higher prevalence of angina (10.82 vs. 6.97%) using Rose Criteria. The HIV− persons were significantly more likely to have hypertension, diabetes, or be overweight or obese than HIV+ persons. Approximately 56% of the cohort had at least 2 measured or self-reported clinical co-morbidities, with HIV+ persons having a consistently lower prevalence of co-morbidities compared to those without HIV. Absolute 10-year risk cardiovascular risk scores ranged from 7.7–9.7% for women and from 12.5–15.3% for men, depending on the risk score equations used.ConclusionsThis cohort has high CMD risk based on both traditional risk factors and novel markers like hsCRP. Longitudinal follow-up of the cohort will allow us to determine the long-term impact of increased lifespan in a population with both high HIV infection and CMD risk.

Heart Rate Variability, HIV and the Risk of Cardiovascular Diseases in Rural South Africa

“…In contrast to most studies from high-income countries (HIC), we found a lower prevalence of conventional CVD risk factors in the HIV-infected population on ART compared to the HIV-uninfected population [4]. These findings are in line with other publications on CVD risk in SSA [24,25]. The difference in CVD risk profile between the HIV-infected population in HIC and low-to middle-income countries (LMIC) most likely reflects the differences in the HIV epidemic between HIC and LMIC.…”

Longitudinal evaluation of markers of inflammation in HIV‐positive and HIV‐negative Rwandan women

“…At baseline and at follow-up, however, the mean levels of hsCRP in HIV-negative women remained at average risk levels according to the Centers for Disease Control and Prevention and the American Heart Association [60]. Interestingly, women in a 2017 study of South Africans with a 22% prevalence of HIV infection had a high mean hsCRP concentration at baseline (3.3 mg/dL), which was also higher than the male mean baseline hsCRP concentration (3.1 mg/dL) [15]. HIV-positive women in our study had higher baseline values compared with HIV-negative women, consistent with other studies [21,56,61].…”

“…In PLWH, high-sensitivity C-reactive protein (hsCRP), D-dimer and transthyretin (prealbumin) have previously been examined as markers of inflammation. hsCRP is elevated in HIV-infected individuals compared with HIV-negative individuals, and independently predicts HIV-related mortality, HIV disease progression and risk for AIDS-and non-AIDS-related events [13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Higher D-dimer concentration in HIV infection has been associated with increased all-cause mortality and non-AIDS-related deaths [4,9,[29][30][31][32][33][34], although results may be inconsistent in women [34][35][36].…”

Hypertension and diabetes control along the HIV care cascade in rural South Africa

“…Participants in HAALSI were randomly sampled from the Agincourt Health and Demographic Surveillance Site (HDSS). Enrollment took place from November 2014 to November 2015 . The baseline survey was administered by local fieldworkers and participant responses recorded in a Computer‐Assisted Personal Interview system .…”