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Distribution and performance of cardiovascular risk scores in a mixed population of HIV-infected and community-based HIV-uninfected individuals in Uganda

  • 2018/04/11
Type de publication
  • Articles
  • Muiru AN; Bibangambah P; Hemphill L; Sentongo R; Kim JH; Triant VA; Bangsberg DR; Tsai AC; Martin JN; Haberer JE; Boum Y 2nd; Plutzky J; Hunt PW; Okello S; Siedner MJ
  • VIH
The utility and validity of CVD risk scores are not well-studied in sub-Saharan Africa. We compared and correlated CVD risk scores with carotid intima media thickness (c-IMT) among HIV-infected and uninfected people in Uganda.
We first calculated CVD risk using the 1) Framingham laboratory-based score; 2) Framingham non-laboratory score (FRS-BMI); 3) Reynolds risk score; 4) American College of Cardiology and American Heart Association score; and 5) the Data-collection on Adverse Effects of Anti-HIV Drugs score. We then compared absolute risk scores and risk categories across each score using Pearson correlation, and kappa statistics, respectively. Finally, we fit linear regression models to estimate the strength of association between each risk score and c-IMT.
Of 205 participants, half were female and median age was 49 years (IQR 46, 53). Median CD4 count was 430 cells/mm (IQR 334, 546), with median 7 years of ART exposure (IQR 6.4, 7.5). HIV-uninfected participants had a higher median systolic blood pressure (121 mmHg vs. 110 mmHg), prevalent current smoking (18% vs. 4%, p=0.001), higher median CVD risk scores (p<0.003), and greater c-IMT (0.68 vs. 0.63, p=0.003). Overall, FRS-BMI was highly correlated with other risk scores (all rho >0.80). In linear regression models, we found significant correlations between increasing CVD risk and higher c-IMT (p<0.01 in all models).
In this cross-sectional study from Uganda, the FRS-BMI correlated well with standard risk scores and c-IMT. HIV-uninfected individuals had higher risk scores than HIV-infected individuals, and the difference appeared to be driven by modifiable factors.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC) , where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.