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ECG Abnormalities and Arterial Stiffness by HIV Status among High-Risk Populations in Rakai, Uganda: A Pilot Study
Rocio Enriquez1, Robert Ssekubugu1,2, Godfrey Kigozi2
1Department of Global Public Health, Karolinska Institutet, Stockholm, SE.
Insights
Incorporating ECG and arterial function tests into HIV cohort studies in sub-Saharan Africa is feasible. These tests reveal high rates of left ventricular hypertrophy and arterial stiffness, regardless of HIV status, with increased arterial stiffness noted in people living with HIV.
Area of Science:
- Cardiology
- Public Health
- Infectious Diseases
Background:
- People living with HIV (PLWH) face elevated cardiovascular disease (CVD) risk.
- Collecting population-based CVD data in sub-Saharan Africa is challenging.
- Proxy measures like ECG and arterial function tests offer a feasible alternative for CVD assessment.
Purpose of the Study:
- To evaluate the acceptability of integrating ECG and arterial function measurements into a population-based cohort study in Uganda.
- To determine the prevalence of ECG abnormalities and arterial stiffness in high-risk populations, including PLWH.
Main Methods:
- A pilot study was conducted within the Rakai Community Cohort Study.
- Participants included two high-risk CVD groups: aged 35-49 (with Framingham CVD risk scores) and aged 50+.
- Data collected included ECG, arterial function, blood pressure, and HIV status. Acceptability was defined as a <5% difference compared to blood pressure measurements.
Main Results:
- 118 participants (57 PLWH, 61 HIV-negative) were enrolled; ECG and arterial function measurements were well accepted (2% difference).
- Left ventricular hypertrophy (LVH) and arterial stiffness (>10 m/s) were prevalent in both PLWH and HIV-negative individuals (30-53% for LVH, 25-58% for arterial stiffness).
- Arterial stiffness at 11 m/s was significantly more common in the 35-49 age group among PLWH (p=0.03).
Conclusions:
- Integrating ECG and arterial function measurements into population-based cohort studies is acceptable and should be further explored.
- LVH and arterial stiffness are common cardiovascular risk factors in this population, irrespective of HIV status.
- Arterial stiffness may be more prevalent among people living with HIV, highlighting a potential area for targeted CVD prevention.
Background:
People living with HIV are at increased risk for cardiovascular disease (CVD). In sub-Saharan Africa, population-based data on major CVD events such as stroke and myocardial infarction are difficult to collect. The use of proxy measures could be a feasible way to better study CVD in such settings. This study aimed to determine the acceptance of incorporating ECG and arterial function measurements into a population-based cohort study and to assess the prevalence of ECG abnormalities and arterial stiffness.
Methods:
A pilot study was conducted within the Rakai Community Cohort Study in Uganda on two high-risk CVD populations; one determined by age (35-49) and Framingham CVD risk scores and the other by age alone (50+). Data on ECG, arterial function, blood pressure, and HIV status were collected. The acceptability of incorporating ECG and arterial function measurements was established as an acceptance rate difference of no more than 5% to blood pressure measurements.
Results:
A total of 118 participants were enrolled, 57 participants living with HIV and 61 HIV-negative participants. Both ECG measurements and arterial function were well accepted (2% difference). Left ventricular hypertrophy (LVH) and arterial stiffness (>10 m/s) were common in both participants living with HIV and HIV-negative participants across the two high-risk populations. Prevalence rates ranged from 30% to 53% for LVH and 25% to 58% for arterial stiffness. Arterial stiffness at the 11 m/s cutoff (p = 0.03) was found to be more common among participants living with HIV in the 35-49 population.
Conclusions:
The incorporation of ECG and arterial function measurements into routine activities of a population-based cohort was acceptable and incorporating these proxy measures into cohort studies should be explored further. LVH and arterial stiffness were both common irrespective of HIV status with arterial stiffness potentially more common among people living with HIV.
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