Coronary artery calcium, HIV and inflammation in Uganda compared with the USA
Ben Alencherry1, Geoffrey Erem2,3, Grace Mirembe4
1Medicine and Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Insights
Older Ugandans, including people living with HIV (PLWH), had significantly lower coronary artery calcium (CAC) prevalence than US individuals, despite higher rates of diabetes and hypertension. HIV status did not influence CAC, but nadir CD4 count was associated with CAC in PLWH.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Cardiovascular disease is a leading cause of mortality in people living with HIV (PLWH).
- Subclinical coronary atherosclerosis, indicated by coronary artery calcium (CAC), is a key concern in managing cardiovascular risk in PLWH.
- Understanding geographic variations in CAC prevalence and associated risk factors is crucial for targeted interventions.
Purpose of the Study:
- To compare CAC prevalence between higher-risk, older people living with HIV (PLWH) and uninfected individuals in Uganda and the USA.
- To investigate associations between CAC and HIV-specific factors, as well as biomarkers of inflammation in these populations.
Main Methods:
- A cross-sectional study involving 430 participants (100 PLWH and 100 controls in Uganda; 167 PLWH and 63 controls in the USA).
- Participants were on antiretroviral therapy (ART) if living with HIV.
- Multivariable logistic regression analysis was employed to assess associations with detectable CAC (CAC >0).
Main Results:
- Ugandans were older, more likely to have diabetes and hypertension, but less likely to be male or smokers compared to US subjects.
- After adjusting for confounders, Ugandans exhibited substantially lower odds of detectable CAC (adjusted OR 0.07; 95% CI 0.03–0.17; p<0.001).
- HIV serostatus was not significantly associated with CAC in either country. Among all PLWH, nadir CD4 count was associated with CAC. In Ugandans, soluble intercellular adhesion molecule, soluble CD163, and oxidized low-density lipoprotein were associated with CAC.
Conclusions:
- Ugandan subjects demonstrated a markedly lower prevalence of coronary calcification compared to US subjects.
- The study highlights the need for further research into the roles of HIV infection and inflammation in subclinical coronary disease within sub-Saharan Africa.
Objectives:
To compare the prevalence of detectable coronary artery calcium (CAC) among higher risk, older people living with HIV (PLWH) and uninfected persons in Uganda versus the USA, and second to explore associations of CAC with HIV-specific variables and biomarkers of inflammation.
Methods:
This cross-sectional study of 430 total subjects compared 100 PLWH on antiretroviral therapy and 100 age-matched and sex-matched HIV-uninfected controls in Uganda with 167 PLWH on antiretroviral therapy and 63 uninfected controls in the USA. Multivariable logistic regression was used to examine associations with detectable CAC (CAC >0).
Results:
Compared with US subjects, Ugandans were older (mean age 56 vs 52 years) and were more likely to have diabetes (36% vs 3%) and hypertension (85% vs 36%), but were less likely to be male (38% vs 74%) or smokers (4% vs 56%). After adjustment for HIV serostatus, age, sex and traditional risk factors, Ugandans had substantially lower odds of CAC >0 (adjusted OR 0.07 (95% CI 0.03 to 0.17), p<0.001). HIV was not associated with CAC >0 in either country (p>0.1). Among all PLWH, nadir CD4 count was associated with the presence of CAC, and among Ugandans soluble intercellular adhesion molecule (p=0.044), soluble CD163 (p=0.004) and oxidised low-density lipoprotein (p=0.043) were all associated with the presence of CAC.
Conclusions:
Ugandans had a dramatically lower prevalence of any coronary calcification compared with US subjects. The role of HIV infection and inflammation as risk factors for subclinical coronary disease in sub-Saharan Africa merits further investigation.
More Related Videos
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:38Inflammation
01:30Coronary Artery Disease III: Clinical Manifestations
01:26Coronary Artery Disease IV: Preventive Measures