title: 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: A 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.
  
  
  
  We 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.
  
  
  
  Five 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.
  
  
  
  This 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.
authors.affiliation: Department of Cardiovascular Medicine, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. tgaziano@partners.org.|Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA, 02115, USA. tgaziano@partners.org.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gaziano
authors.affiliation: Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA, 02115, USA.
authors.forename: Shafika
authors.initials: S
authors.lastname: Abrahams-Gessel
authors.affiliation: Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA.|Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew's Road, Johannesburg, Parktown, 2193, South Africa.|INDEPTH Network, Accra, Ghana.|Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Gomez-Olive
authors.affiliation: Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew's Road, Johannesburg, Parktown, 2193, South Africa.|INDEPTH Network, Accra, Ghana.|Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa.|School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Alisha
authors.initials: A
authors.lastname: Wade
authors.affiliation: National Health Laboratory Service and Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd., Johannesburg, Parktown, 2193, South Africa.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Crowther
authors.affiliation: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
authors.forename: Sartaj
authors.initials: S
authors.lastname: Alam
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.|Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Manne-Goehler
authors.affiliation: Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew's Road, Johannesburg, Parktown, 2193, South Africa.|INDEPTH Network, Accra, Ghana.|Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa.|Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Chodziwadziwa W
authors.initials: CW
authors.lastname: Kabudula
authors.affiliation: Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew's Road, Johannesburg, Parktown, 2193, South Africa.|INDEPTH Network, Accra, Ghana.|Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa.|Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden.
authors.forename: Ryan
authors.initials: R
authors.lastname: Wagner
authors.affiliation: Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Rohr
authors.affiliation: Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA.
authors.forename: Livia
authors.initials: L
authors.lastname: Montana
authors.affiliation: Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew's Road, Johannesburg, Parktown, 2193, South Africa.|INDEPTH Network, Accra, Ghana.|Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa.|School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.|Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.affiliation: Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.|Africa Health Research Institute (AHRI), Mtubatuba, South Africa.|Institute of Public Health, Faculty of Medicine, University of Heidelberg, INF 130.3, Heidelberg, Baden-Württemberg, 69120, Germany.
authors.forename: Till W
authors.initials: TW
authors.lastname: Bärnighausen
authors.affiliation: Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge, MA, 02138, USA.
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Berkman
authors.affiliation: Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew's Road, Johannesburg, Parktown, 2193, South Africa.|INDEPTH Network, Accra, Ghana.|Africa Wits-INDEPTH Genomic Studies of Cardiovascular Disease, University of the Witwatersrand, Johannesburg, South Africa.|Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden.
authors.forename: Stephen
authors.initials: S
authors.lastname: Tollman
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001786:Blood Glucose; D001794:Blood Pressure; D001837:Body Weights and Measures; D002097:C-Reactive Protein; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006442:Glycated Hemoglobin; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007407:Interviews as Topic; D008017:Life Expectancy; D008055:Lipids / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D049629:Waist-Hip Ratio
chemical_list: D044966:Anti-Retroviral Agents; D001786:Blood Glucose; D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D008055:Lipids
keywords: Aging; Antiretrovirals; Cardiometabolic; Cardiovascular; Diabetes; HIV; Hypertension