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Cardiovascular risk factors and markers of myocardial injury and inflammation in people living with HIV in Nairobi, Kenya: a pilot cross-sectional study

ObjectivesTo determine the prevalence of cardiovascular disease (CVD) risk factors and explore associations with high-sensitivity cardiac troponin I (hscTnI) and high-sensitivity C-reactive protein (hsCRP) in people living with HIV (PLHIV) in Kenya.DesignPilot cross-sectional study.SettingData were...

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Published in:BMJ open 2022-06, Vol.12 (6), p.e062352-e062352
Main Authors: Ahmed, Hassan Adan, Mohamed, Jeilan, Akuku, Isaiah G, Lee, Kuan Ken, Alam, Shirjel R, Perel, Pablo, Shah, Jasmit, Ali, Mohammed K, Eskander, Sherry, Chung, Michael H, Shah, Anoop SV
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creator Ahmed, Hassan Adan
Mohamed, Jeilan
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Eskander, Sherry
Chung, Michael H
Shah, Anoop SV
description ObjectivesTo determine the prevalence of cardiovascular disease (CVD) risk factors and explore associations with high-sensitivity cardiac troponin I (hscTnI) and high-sensitivity C-reactive protein (hsCRP) in people living with HIV (PLHIV) in Kenya.DesignPilot cross-sectional study.SettingData were collected from community HIV clinics across two sites in Nairobi, Kenya, from July 2019 to May 2020.ParticipantsConvenience sample of 200 PLHIV (≥30 years with no prior history of CVD).Outcome measuresPrevalence of cardiovascular risk factors and its association with hsTnI and hsCRP levels.ResultsAcross 200 PLHIV (median age 46 years, IQR 38–53; 61% women), the prevalence of hypercholesterolaemia (total cholesterol >6.1 mmol/L) and hypertension were 19% (n=30/199) and 30% (n=60/200), respectively. Smoking and diabetes prevalence was 3% (n=5/200) and 4% (n=7/200). HscTnI was below the limit of quantification (3 mg/L), intermediate (1–3 mg/L) and low (160 mm Hg (aOR 4.68, 95% CI 1.55 to 14) compared with
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Smoking and diabetes prevalence was 3% (n=5/200) and 4% (n=7/200). HscTnI was below the limit of quantification (&lt;2.5 ng/L) in 65% (n=109/169). High (&gt;3 mg/L), intermediate (1–3 mg/L) and low (&lt;1 mg/L) hsCRP levels were found in 38% (n=75/198), 33% (n=65/198) and 29% (n=58/198), respectively. Framingham laboratory-based risk scores classified 83% of PLHIV at low risk with 12% and 5% at intermediate and high risk, respectively. Older age (adjusted OR (aOR) per year increase 1.05, 95% CI 1.01 to 1.08) and systolic blood pressure (140–159 mm Hg (aOR 2.96; 95% CI 1.09 to 7.90) and &gt;160 mm Hg (aOR 4.68, 95% CI 1.55 to 14) compared with &lt;140 mm Hg) were associated with hscTnI levels. No associations were observed between hsCRP and CVD risk factors.ConclusionThe majority of PLHIV—using traditional risk estimation systems—have a low estimated CVD risk likely reflecting a younger aged population predominantly consisting of women. Hypertension and hypercholesterolaemia were common while smoking and diabetes rates remained low. While hscTnI values were associated with increasing age and raised blood pressure, no associations between hsCRP levels and traditional cardiovascular risk factors were observed.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2022-062352</identifier><identifier>PMID: 35667720</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>Adult cardiology ; Blood pressure ; Cardiovascular Medicine ; Cross-sectional studies ; Diabetes ; EPIDEMIOLOGY ; HIV ; HIV &amp; AIDS ; Human immunodeficiency virus ; Hypertension ; Risk factors</subject><ispartof>BMJ open, 2022-06, Vol.12 (6), p.e062352-e062352</ispartof><rights>Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2022 Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b4542-97c554448239b77eeaaea57a96e200cdb272e75cf36c120205ef9979e179918d3</citedby><cites>FETCH-LOGICAL-b4542-97c554448239b77eeaaea57a96e200cdb272e75cf36c120205ef9979e179918d3</cites><orcidid>0000-0002-2099-612X ; 0000-0003-3248-7418</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2674553229/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2674553229?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,3180,25732,27903,27904,36991,36992,44569,53769,53771,55319,55328,74872,77342,77343,77406,77432</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35667720$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ahmed, Hassan Adan</creatorcontrib><creatorcontrib>Mohamed, Jeilan</creatorcontrib><creatorcontrib>Akuku, Isaiah G</creatorcontrib><creatorcontrib>Lee, Kuan Ken</creatorcontrib><creatorcontrib>Alam, Shirjel R</creatorcontrib><creatorcontrib>Perel, Pablo</creatorcontrib><creatorcontrib>Shah, Jasmit</creatorcontrib><creatorcontrib>Ali, Mohammed K</creatorcontrib><creatorcontrib>Eskander, Sherry</creatorcontrib><creatorcontrib>Chung, Michael H</creatorcontrib><creatorcontrib>Shah, Anoop SV</creatorcontrib><title>Cardiovascular risk factors and markers of myocardial injury and inflammation in people living with HIV in Nairobi, Kenya: a pilot cross-sectional study</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><addtitle>BMJ Open</addtitle><description>ObjectivesTo determine the prevalence of cardiovascular disease (CVD) risk factors and explore associations with high-sensitivity cardiac troponin I (hscTnI) and high-sensitivity C-reactive protein (hsCRP) in people living with HIV (PLHIV) in Kenya.DesignPilot cross-sectional study.SettingData were collected from community HIV clinics across two sites in Nairobi, Kenya, from July 2019 to May 2020.ParticipantsConvenience sample of 200 PLHIV (≥30 years with no prior history of CVD).Outcome measuresPrevalence of cardiovascular risk factors and its association with hsTnI and hsCRP levels.ResultsAcross 200 PLHIV (median age 46 years, IQR 38–53; 61% women), the prevalence of hypercholesterolaemia (total cholesterol &gt;6.1 mmol/L) and hypertension were 19% (n=30/199) and 30% (n=60/200), respectively. Smoking and diabetes prevalence was 3% (n=5/200) and 4% (n=7/200). HscTnI was below the limit of quantification (&lt;2.5 ng/L) in 65% (n=109/169). High (&gt;3 mg/L), intermediate (1–3 mg/L) and low (&lt;1 mg/L) hsCRP levels were found in 38% (n=75/198), 33% (n=65/198) and 29% (n=58/198), respectively. Framingham laboratory-based risk scores classified 83% of PLHIV at low risk with 12% and 5% at intermediate and high risk, respectively. Older age (adjusted OR (aOR) per year increase 1.05, 95% CI 1.01 to 1.08) and systolic blood pressure (140–159 mm Hg (aOR 2.96; 95% CI 1.09 to 7.90) and &gt;160 mm Hg (aOR 4.68, 95% CI 1.55 to 14) compared with &lt;140 mm Hg) were associated with hscTnI levels. No associations were observed between hsCRP and CVD risk factors.ConclusionThe majority of PLHIV—using traditional risk estimation systems—have a low estimated CVD risk likely reflecting a younger aged population predominantly consisting of women. Hypertension and hypercholesterolaemia were common while smoking and diabetes rates remained low. While hscTnI values were associated with increasing age and raised blood pressure, no associations between hsCRP levels and traditional cardiovascular risk factors were observed.</description><subject>Adult cardiology</subject><subject>Blood pressure</subject><subject>Cardiovascular Medicine</subject><subject>Cross-sectional studies</subject><subject>Diabetes</subject><subject>EPIDEMIOLOGY</subject><subject>HIV</subject><subject>HIV &amp; AIDS</subject><subject>Human immunodeficiency virus</subject><subject>Hypertension</subject><subject>Risk factors</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp9ksFu1DAQhiMEolXpEyAhS1w4EOo4drzmgFStgK6o4AJcrYkz2XqbxMFOFuVNeFyczVJaDuRiO_7msz36k-R5Rt9kWV5clO3O9diljDKW0oLlgj1KThnlPC2oEI_vzU-S8xB2NH5cKCHY0-QkF0UhJaOnya81-Mq6PQQzNuCJt-GW1GAG5wOBriIt-FuMc1eTdnJmpqEhttuNfjoAtqsbaFsYrOvigvTo-gZJY_e225KfdrghV5vv885nsN6V9jX5hN0EbwmQ3jZuIMa7ENKAZlZEeRjGanqWPKmhCXh-HM-Sbx_ef11fpddfPm7Wl9dpyQVnqZJGCM75iuWqlBIRAEFIUAUySk1VMslQClPnhclis6jAWimpMJNKZasqP0s2i7dysNO9t_HBk3Zg9eGH81sNfrCmQU1RoakEX9Wq4qWcR4mSlSVDuiprE13vFlc_li1WBrvBQ_NA-nCnszd66_ZaZTJjgkfBq6PAux8jhkG3NhhsGujQjUGzQnJK2UrRiL78B9250cf2LZQQOWMqUvlCHXrssb67TEb1HCR9DJKeg6SXIMWqF_ffcVfzJzYRuFiAWP333P8pfwPkwNcu</recordid><startdate>20220606</startdate><enddate>20220606</enddate><creator>Ahmed, Hassan Adan</creator><creator>Mohamed, Jeilan</creator><creator>Akuku, Isaiah G</creator><creator>Lee, Kuan Ken</creator><creator>Alam, Shirjel R</creator><creator>Perel, Pablo</creator><creator>Shah, Jasmit</creator><creator>Ali, Mohammed K</creator><creator>Eskander, Sherry</creator><creator>Chung, Michael H</creator><creator>Shah, Anoop SV</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-2099-612X</orcidid><orcidid>https://orcid.org/0000-0003-3248-7418</orcidid></search><sort><creationdate>20220606</creationdate><title>Cardiovascular risk factors and markers of myocardial injury and inflammation in people living with HIV in Nairobi, Kenya: a pilot cross-sectional study</title><author>Ahmed, Hassan Adan ; Mohamed, Jeilan ; Akuku, Isaiah G ; Lee, Kuan Ken ; Alam, Shirjel R ; Perel, Pablo ; Shah, Jasmit ; Ali, Mohammed K ; Eskander, Sherry ; Chung, Michael H ; Shah, Anoop SV</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b4542-97c554448239b77eeaaea57a96e200cdb272e75cf36c120205ef9979e179918d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult cardiology</topic><topic>Blood pressure</topic><topic>Cardiovascular Medicine</topic><topic>Cross-sectional studies</topic><topic>Diabetes</topic><topic>EPIDEMIOLOGY</topic><topic>HIV</topic><topic>HIV &amp; AIDS</topic><topic>Human immunodeficiency virus</topic><topic>Hypertension</topic><topic>Risk factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ahmed, Hassan Adan</creatorcontrib><creatorcontrib>Mohamed, Jeilan</creatorcontrib><creatorcontrib>Akuku, Isaiah G</creatorcontrib><creatorcontrib>Lee, Kuan Ken</creatorcontrib><creatorcontrib>Alam, Shirjel R</creatorcontrib><creatorcontrib>Perel, Pablo</creatorcontrib><creatorcontrib>Shah, Jasmit</creatorcontrib><creatorcontrib>Ali, Mohammed K</creatorcontrib><creatorcontrib>Eskander, Sherry</creatorcontrib><creatorcontrib>Chung, Michael H</creatorcontrib><creatorcontrib>Shah, Anoop SV</creatorcontrib><collection>BMJ Journals (Open Access)</collection><collection>BMJ Journals:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; 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61% women), the prevalence of hypercholesterolaemia (total cholesterol &gt;6.1 mmol/L) and hypertension were 19% (n=30/199) and 30% (n=60/200), respectively. Smoking and diabetes prevalence was 3% (n=5/200) and 4% (n=7/200). HscTnI was below the limit of quantification (&lt;2.5 ng/L) in 65% (n=109/169). High (&gt;3 mg/L), intermediate (1–3 mg/L) and low (&lt;1 mg/L) hsCRP levels were found in 38% (n=75/198), 33% (n=65/198) and 29% (n=58/198), respectively. Framingham laboratory-based risk scores classified 83% of PLHIV at low risk with 12% and 5% at intermediate and high risk, respectively. Older age (adjusted OR (aOR) per year increase 1.05, 95% CI 1.01 to 1.08) and systolic blood pressure (140–159 mm Hg (aOR 2.96; 95% CI 1.09 to 7.90) and &gt;160 mm Hg (aOR 4.68, 95% CI 1.55 to 14) compared with &lt;140 mm Hg) were associated with hscTnI levels. No associations were observed between hsCRP and CVD risk factors.ConclusionThe majority of PLHIV—using traditional risk estimation systems—have a low estimated CVD risk likely reflecting a younger aged population predominantly consisting of women. Hypertension and hypercholesterolaemia were common while smoking and diabetes rates remained low. While hscTnI values were associated with increasing age and raised blood pressure, no associations between hsCRP levels and traditional cardiovascular risk factors were observed.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>35667720</pmid><doi>10.1136/bmjopen-2022-062352</doi><orcidid>https://orcid.org/0000-0002-2099-612X</orcidid><orcidid>https://orcid.org/0000-0003-3248-7418</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult cardiology
Blood pressure
Cardiovascular Medicine
Cross-sectional studies
Diabetes
EPIDEMIOLOGY
HIV
HIV & AIDS
Human immunodeficiency virus
Hypertension
Risk factors
title Cardiovascular risk factors and markers of myocardial injury and inflammation in people living with HIV in Nairobi, Kenya: a pilot cross-sectional study
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