Cardiovascular Journal of Africa: Vol 30 No 1 (January/February 2019)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 1, January/February 2019 54 AFRICA
whereas 0.4% (seven) had known diabetes and 0.3% (four) had
had a previous cardiovascular event (heart attack or stroke).
The median BMI was 21 (IQR 20–23) kg/m2 with 11% of
subjects underweight, 12% overweight and 2% obese. Waist
circumference was > 100 cm (102 cm) in 1% of men and > 90 cm
(88 cm) in 7.5% of women (Table 1). The median duration on
ART was 32.5 (17.4–50.6) months. Cardiovascular risk-factor
distribution stratified by ART status is shown in Table 2.
Of the 1 502 individuals screened, 40.4% (609/1502) had
pre-hypertension, 10.4% (157/1502) were stage 1 and 2.9%
(43/1502) were stage 2 hypertension. In multivariate analysis,
hypertension was associated with being male [adjusted OR 1.59
(1.26–2.01), p = 0.0001], being 40 years or older [adjusted OR
1.78 (1.44–2.21), p = 0.0001], and having an increased waist
circumference [adjusted OR 2.56 (1.44–4.55), p = 0.0014].
While the association between lower CD4 count and
prevalence of hypertension was not certain, lower CD4 count
was indicative of a lower prevalence of hypertension among
those with low CD4 counts. There was no association between
hypertension and current ART regimen (Table 3). The median
duration on ART was not significantly different for those with or
without hypertension (Mann–Whitney test, p = 0.6794).
A total of 207 (14%) patients had an elevated non-fasting
total cholesterol level (> 5.2 mmol/l). On multivariate analysis,
being above 40 years of age [adjusted OR 1.95 (1.42–2.69), p
= 0.001] and having an increased waist circumference [adjusted
OR 2.06 (1.14–3.71), p = 0.0164] were associated with having a
raised total cholesterol level. In addition, raised total cholesterol
was more likely in those on TDF [adjusted OR 2.20 (1.28–3.78),
p = 0.0042], AZT [adjusted OR 2.50 (1.50–4.18), p = 0.004]
Table 1. Prevalence of cardiovascular risk factors
among people living with HIV
Variables Frequency (n) Overall %
Age ≥ 40 years 716 47.4
Male gender 471 31.2
Current smokers 29 1.9
Increased waist circumference* 89 5.9
Total cholesterol ≥ 5.2 mmol/l 207 13.7
Body mass index ≥ 25 kg/m2 182 12.1
Random blood glucose ≥ 7.8 mmol/l 31 2.1
Known diabetes at screening 7 0.5
Cardiovascular risk score ≥ 10% 8 0.5
Pre-hypertension 609 40.4
Hypertension stage 1 157 10.4
Hypertension stage 2 43 2.9
*Females ≥ 90 cm, males ≥ 100 cm.
Table 2. Cardiovascular risk factors stratified by ART status
CVD risk factors
ART,
n (%)
Pre-ART,
n (%) p-value OR (95% CI)
Male gender 396 (32.5) 74 (26.0) 0.0312 1.38 (1.03–1.84)
Age ≥ 40 years 629 (51.7) 87 (30.5) 0.0001 2.43 (1.85–3.21)
Current smokers 24 (2.0) 5 (1.8) 0.8100 1.13 (0.43–2.98)
Total cholesterol ≥ 5.2
mmol/l
186 (15.3) 19 (6.7) 0.0001 2.53 (1.55–4.13)
Body mass index ≥ 25 kg/m 2 151 (12.4) 31 (10.9) 0.4761 1.16 (0.77–1.75)
Elevated waist
circumference*
76 (6.2) 13 (4.6) 0.2786 1.39 (0.76–2.55)
Random blood glucose
≥ 7.8 mmol/l
25 (2.1) 5 (1.8) 0.7447 1.17 (0.45–3.10)
Cardiovascular risk score
≥ 10%
6 (0.5) 2 (0.7) 0.6630 0.70 (0.14–3.49)
Known diabetes 6 (0.5) 1 (0.4) 1.000 1.41 (0.17–11.70)
Hypertension 666 (54.7) 140 (49.3) 0.0985 1.24 (0.96–1.61)
Pre-hypertension 494 (47.3) 113 (44.0) 0.3415 1.14 (0.96–1.61)
Hypertension stage 1 132 (19.3) 24 (14.3) 0.1303 1.44 (0.90–2.30)
Hypertension stage 2 40 (6.6) 3 (2.0) 0.0291* 3.48 (1.06–11.42)
*Females ≥ 90 cm, males ≥ 100 cm; Fischer’s exact two-sided test.
Table 3. Unadjusted and adjusted odds ratios for hypertension
Characteristic
Unadjusted OR Adjusted OR
OR (95% CI) p-value OR (95% CI) p-value
Male gender 1.65 (1.32–2.06) 0.0001 1.68 (1.32–2.14) 0.0001
Age ≥ 40 years 2.06 (1.67–2.53) 0.0001 1.78 (1.43–2.22) 0.0001
Current smokers 1.42 (0.67–3.02 0.3653 1.02 (0.47–2.24) 0.9574
Body mass index
≥ 30 kg/m2
3.14 (1.35–7.31) 0.0079 1.47 (0.55–3.94) 0.4421
Random blood glucose
≥ 7.8mmol/l
1.13 (0.54–2.34) 0.7459 1.09 (0.51–2.33) 0.8225
Increased waist
circumference*
2.95 (1.79–4.87) 0.0001 2.49 (1.39–4.43) 0.0020
ART regimen
No ART Ref Ref Ref Ref
TDF-based 1.18 (0.88–1.58) 0.2794 1.10 (0.81–1.49) 0.5506
AZT-based 1.40 (1.07–1.84) 0.0152 1.26 (0.95–1.68) 0.1090
D4T-based 1.42 (0.97–2.06) 0.068 1.22 (0.82–1.81) 0.3226
LPV-based 0.91 (0.41–2.03) 0.8212 0.97 (0.42–2.25) 0.9385
CD4 count (cells/mm3)
Missing 0.71 (0.53–0.94) 0.0165 0.72 (0.54–0.97) 0.0307
0–100 0.47 (0.23–0.92) 0.0287 0.49 (0.24–0.99) 0.0472
101–200 0.78 (0.47–1.29) 0.3369 0.67 (0.40–1.14) 0.1406
201–350 0.67 (0.50–0.91) 0.0112 0.59 (0.43–0.82) 0.0015
351–500 0.84 (0.62–1.12) 0.2315 0.77 (0.56–1.04) 0.0882
> 500 Ref Ref Ref Ref
*Females≥ 90 cm, males ≥ 100 cm.
Table 4. Unadjusted and adjusted odds ratios
for elevated total cholesterol
Characteristic
Unadjusted OR Adjusted OR
OR (95% CI) p-value OR (95% CI) p-value
Male gender 0.85 (0.61–1.17) 0.3194 0.83 (0.59–1.17) 0.2806
Age ≥ 40 years 2.21 (1.63–3.00) 0.0001 1.95 (1.42–2.69) 0.0001
Smoker 0.22 (0.03–1.64) 0.1404 0.22 (0.03–1.67) 0.1434
BMI ≥ 30 kg/m2 2.15 (0.95–4.86) 0.0647 1.03 (0.39–2.74) 0.946
Random blood glucose
≥ 7.8 mmol/l
1.96 (0.83–4.62) 0.1252 1.99 (0.82–4.81) 0.1278
Increased waist circum-
ference*
2.68 (1.64–4.36) 0.0001 2.06 (1.14–3.71) 0.0164
ART regimen
No ART Ref Ref Ref Ref
TDF-based 2.47 (1.45–4.22) 0.0009 2.20 (1.28–3.78) 0.0042
AZT-based 2.84 (1.72–4.71) 0.0001 2.50 (1.50–4.18) 0.0004
D4T-based 3.86 (2.14–6.95) 0.0001 3.13 (1.72–5.71) 0.0002
LPV-based 1.98 (0.55–7.17) 0.2968 1.85 (0.50–6.80) 0.3536
CD4 count (cells/mm3)
Missing 0.74 (0.49–1.11) 0.147 0.87 (0.57–1.33) 0.5217
0–100 1.04 (0.42–2.60) 0.9306 1.13 (0.44–2.92) 0.7964
101–200 0.48 (0.20–1.16) 0.1029 0.46 (0.19–1.13) 0.0885
201–350 0.79 (0.51–1.22) 0.2884 0.79 (0.50–1.25) 0.3174
351–500 0.93 (0.62–1.39) 0.7106 0.92 (0.60–1.41) 0.6951
> 500 Ref Ref Ref Ref
*Females≥ 90 cm, males ≥ 100 cm.