title: Ideal Cardiovascular Health and Carotid Atherosclerosis in a Mixed Cohort of HIV-Infected and Uninfected Ugandans.
abstract: Preventable cardiovascular disease (CVD) risk factors are responsible for the majority of CVD-related deaths, and are increasingly recognized as a cause of morbidity and mortality for HIV-infected persons taking antiretroviral therapy (ART). Simplified tools such as the American Heart Association's ideal cardiovascular health (iCVH) construct may identify and prognosticate CVD risk in resource-limited settings. No studies have evaluated iCVH metrics in sub-Saharan Africa or among HIV-infected adults. Thus, the central aim of this study was to compare levels of iCVH metrics and their correlations with carotid atherosclerosis for HIV-infected adults versus uninfected controls in a well-phenotyped Ugandan cohort. We analyzed the prevalence of iCVH metrics in a mixed cohort of HIV-infected persons on stable ART and uninfected, population-based comparators in Mbarara, Uganda. We also assessed the validity of iCVH by correlating iCVH values with common carotid intima media thickness (CCIMT). HIV-infected persons had a mean of 4.9 (SD 1.1) iCVH metrics at ideal levels versus 4.3 (SD 1.2) for uninfected controls (p = .002). This difference was largely driven by differences in blood pressure, blood glucose, and diet. In multivariable-adjusted linear regression models, each additional iCVH metric at an ideal level was associated with a significant 0.024 mm decrease in CCIMT (p < .001).HIV-infected persons on ART in rural Uganda had more iCVH metrics at ideal levels than uninfected persons. The difference appeared driven by factors that are putatively influenced by access to routine medical care. Composite scores of iCVH metrics were associated with subclinical atherosclerosis and more predictive of atherosclerosis for uninfected persons.
authors.affiliation: 1 Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Feinstein
authors.affiliation: 2 Department of Medicine, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: June-Ho
authors.initials: JH
authors.lastname: Kim
authors.affiliation: 3 Faculty of Medicine, Mbarara University of Science and Technology , Mbarara, Uganda .
authors.forename: Prossy
authors.initials: P
authors.lastname: Bibangambah
authors.affiliation: 3 Faculty of Medicine, Mbarara University of Science and Technology , Mbarara, Uganda .
authors.forename: Ruth
authors.initials: R
authors.lastname: Sentongo
authors.affiliation: 4 Division of Infectious Diseases, Department of Medicine, University of California-San Francisco , San Francisco, California.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.affiliation: 5 Center for Global Health , Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Tsai
authors.affiliation: 3 Faculty of Medicine, Mbarara University of Science and Technology , Mbarara, Uganda .|5 Center for Global Health , Massachusetts General Hospital, Boston, Massachusetts.|6 Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts.|7 Harvard Medical School , Boston, Massachusetts.
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.affiliation: 7 Harvard Medical School , Boston, Massachusetts.|8 Division of Cardiology, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts.
authors.forename: Linda
authors.initials: L
authors.lastname: Hemphill
authors.affiliation: 6 Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts.|7 Harvard Medical School , Boston, Massachusetts.
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Triant
authors.affiliation: 9 Epicentre Research Base , Mbarara, Uganda .
authors.forename: Yap
authors.initials: Y
authors.lastname: Boum
authors.affiliation: 4 Division of Infectious Diseases, Department of Medicine, University of California-San Francisco , San Francisco, California.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.affiliation: 3 Faculty of Medicine, Mbarara University of Science and Technology , Mbarara, Uganda .
authors.forename: Samson
authors.initials: S
authors.lastname: Okello
authors.affiliation: 5 Center for Global Health , Massachusetts General Hospital, Boston, Massachusetts.|6 Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts.|7 Harvard Medical School , Boston, Massachusetts.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Siedner
mesh_terms: D056808:Biostatistics; D002340:Carotid Artery Diseases / Q000175:diagnosis*; D015331:Cohort Studies; D003661:Decision Support Techniques; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014454:Uganda / Q000453:epidemiology
keywords: cardiovascular disease; epidemiology; human immunodeficiency virus; ideal cardiovascular health; primary prevention; risk factors