Cardiovascular disease risk among Chinese antiretroviral-naïve adults with advanced HIV disease

Abstract

BackgroundCardiovascular disease (CVD) is an important cause of mortality among HIV-infected patients, however little is known about the burden of CVD among this population in Asia. We sought to quantify prevalence of CVD risk factors, 10-year CVD risk, and patterns of CVD risk factor treatment in a group of individuals with HIV in China.MethodsWe retrospectively analyzed baseline data from treatment-naïve HIV-infected adults enrolled in two multicenter clinical trials in China. Data regarding CVD risk factors such as smoking, hypertension, diabetes, dyslipidemia and obesity were assessed. The Framingham Risk Score (FRS) and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk scores were calculated to estimate 10-year CVD risk. The American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score was used to identify individuals meeting criteria for lipid-lowering therapy.ResultsIn total, 973 patients were included in the analysis. Mean age was 36.0 ± 10.2 years and 74.2% were men. The most common CVD risk factors were dyslipidemia (51.7%) and smoking (23.7%). Prevalence of hypertension, diabetes and obesity were 8.4%, 4.6% and 1.0%, respectively. Over 65% of patients had at least one CVD risk factor. The prevalence of 10-year risk of CVD ≥10% was 4.5% based upon FRS and was 3.3% based upon D:A:D risk score. Few patients with dyslipidemia, hypertension or diabetes were on treatment.ConclusionsCVD risk factors are common but under-treated among Chinese treatment-naïve individuals with HIV. Future interventions should focus on training HIV providers to appropriately recognize and manage CVD risk factors during routine clinical assessments.

Incidence of hypertension among persons living with HIV in China: a multicenter cohort study

“…We classified body mass index (BMI) using the following categories: underweight < 18.5, normal 18.5-24.9, overweight 25-29.9, and obese ≥30.0 kg/m 2 [18]; and dyslipidemia using the following categories: total cholesterol > 5.2 mmol/l, high-density lipoprotein cholesterol (HDL-c) < 1.0 mmol/l, low-density lipoprotein cholesterol > 4.1 mmol/l, or triglycerides > 1.7 mmol/l [19]. Participants were classified as diabetic if they had a prior diagnosis of diabetes, a fasting plasma glucose ≥7.0 mmol/l or were being treated with insulin or oral hypoglycemic agents [12]. Renal function was assessed by the estimated glomerular filtration rate (eGFR) using the formula from the Chronic Kidney Disease Epidemiology Collaboration [20], and categorized following the chronic kidney disease criteria [21].…”

“…Limited studies have focused on hypertension prevalence among PLWH in Asia [12][13][14], and these have all been cross-sectional in design. We previously reported the prevalence of hypertension was 8.4% among Chinese ART-naïve PLWH [12], which is lower than that reported in the USA and Europe [3]. However, the incidence of hypertension among PLWH in Asia, particularly after initiation of ART, remains unclear.…”

Electrocardiographic abnormalities among people with HIV in Shanghai, China

“…The limited literature suggests that CVD risks (e.g. carotid intima-media thickness [cIMT], chronic kidney disease [CKD], hypertension, glycometabolism abnormities) are prevalent among HIV-infected patients in China (16)(17)(18), but data for ECG manifestations in this population are lacking. To fill this gap, we conducted a cross-sectional study to investigate the prevalence and correlates of ECG abnormalities among PLWH in Shanghai.…”

Incidence of Hypertension among Persons Living with HIV in China A Multicenter Study

“…The prevalence of hypertension observed among ART-naive PLWH in the present study was lower than that reported in the Chinese general population (26.9%), among a nationally representative sample of over 90,000 Chinese adults from 2007-2008 (24). This might be attributable to lower BMI and prevalence of smoking among Chinese ART-naïve PLWH in the present study compared with the general population cohort, or to differences in other risk factors between the time periods during which the two cohorts were enrolled (12,25). The prevalence of hypertension observed in our study was also lower than that reported by Ding et al among Chinese PLWH (23.8%), however that study was carried out in a single study site in Zhejiang province, and included both ART-naïve and ART-experienced PLWH (13).…”