Assessment of cardiovascular disease risks using Framingham risk scores (FRS) in HIV-positive and HIV-negative older adults in South Africa.

Abstract

The relationship between HIV and cardiovascular diseases (CVDs) remains complex. The aim of this study was to estimate the 10-year CVD risk among HIV-positive and HIV-negative people. The validated Framingham Risk Score (FRS) based on the Framingham Heart study was used to predict the CVD risk. Data for this analysis came from a 2016 cross-sectional study of South African community-dwelling older adults (≥50years). Logistic regression models were constructed to assess the association between CVD risk and HIV. 403 respondents with a mean age 60 (SD=6.7) years were enrolled, of whom 70% were female, 75% black African, 21.9% smokers, 77.2% never did any vigorous physical activity, and 17% were HIV-positive. The average 10-year CVD risk was 17%; significantly higher in men than women (23.2 vs 14.3%, p<0.001). Overall, 33% had low CVD risk (FRS<10%), 39% intermediate (FRS 10-19%) and 28% high risk (FRS≥20%). Furthermore, participants who were HIV-positive were less likely than HIV-negative participants to have high CVD risk (aOR 0.27, 95% CI 0.11-0.66, p=0.004). These findings of HIV-positive respondents having lower CVD risk than HIV-negative respondents could be due to three issues i) HIV-positive people having lesser cardio-metabolic disease risk factors; ii) possibly higher health care utilization by HIV-positive people; and/or iii) the neglect of HIV-negative people in HIV focused health systems. Periodic cardiovascular disease monitoring using tools like the Framingham Risk Scores is needed. Furthermore, studies with more robust designs are needed to further elucidate the relationship between HIV and CVD risks in HIV endemic sub-Saharan Africa.