Abstract
BackgroundA consequence of the widespread uptake of anti-retroviral therapy (ART) is that the older South African population will experience an increase in life expectancy, increasing their risk for cardiometabolic diseases (CMD), and its risk factors. The long-term interactions between HIV infection, treatment, and CMD remain to be elucidated in the African population. The HAALSI cohort was established to investigate the impact of these interactions on CMD morbidity and mortality among middle-aged and older adults.MethodsWe recruited randomly selected adults aged 40 or older residing in the rural Agincourt sub-district in Mpumalanga Province. In-person interviews were conducted to collect baseline household and socioeconomic data, self-reported health, anthropometric measures, blood pressure, high-sensitivity C-reactive protein (hsCRP), HbA1c, HIV-status, and point-of-care glucose and lipid levels.ResultsFive thousand fifty nine persons (46.4% male) were enrolled with a mean age of 61.7 ± 13.06 years. Waist-to-hip ratio was high for men and women (0.92 ± 0.08 vs. 0.89 ± 0.08), with 70% of women and 44% of men being overweight or obese. Blood pressure was similar for men and women with a combined hypertension prevalence of 58.4% and statistically significant increases were observed with increasing age. High total cholesterol prevalence in women was twice that observed for men (8.5 vs. 4.1%). The prevalence of self-reported CMD conditions was higher among women, except for myocardial infarction, and women had a statistically significantly higher prevalence of angina (10.82 vs. 6.97%) using Rose Criteria. The HIV− persons were significantly more likely to have hypertension, diabetes, or be overweight or obese than HIV+ persons. Approximately 56% of the cohort had at least 2 measured or self-reported clinical co-morbidities, with HIV+ persons having a consistently lower prevalence of co-morbidities compared to those without HIV. Absolute 10-year risk cardiovascular risk scores ranged from 7.7–9.7% for women and from 12.5–15.3% for men, depending on the risk score equations used.ConclusionsThis cohort has high CMD risk based on both traditional risk factors and novel markers like hsCRP. Longitudinal follow-up of the cohort will allow us to determine the long-term impact of increased lifespan in a population with both high HIV infection and CMD risk.
Highlights
A consequence of the widespread uptake of anti-retroviral therapy (ART) is that the older South African population will experience an increase in life expectancy, increasing their risk for cardiometabolic diseases (CMD), and its risk factors
Gaziano et al BMC Public Health (2017) 17:206 (Continued from previous page). This cohort has high CMD risk based on both traditional risk factors and novel markers like high-sensitivity C-reactive protein (hsCRP)
Dried blood spots (DBS) tests for Human immunodeficiency virus (HIV) antibody tests revealed that 22.5% of the cohort was HIV+ (22.4% males; 22.6% females) and among those who tested positive, the presence of ART medications was detected in 662/1,035 (64%)
Summary
A consequence of the widespread uptake of anti-retroviral therapy (ART) is that the older South African population will experience an increase in life expectancy, increasing their risk for cardiometabolic diseases (CMD), and its risk factors. From the late 1990s to 2011, non-communicable disease mortality increased steadily [3] in adults 50 years and above, due largely to an increase in a number of risk factors such as hypertension, increased smoking prevalence, dietary changes and obesity [5] These risks factors have been followed by increases in symptomatic cardiovascular conditions such as stroke, ischemic heart disease and diabetes, for which health policymakers have yet to evolve an effective response. It is increasingly recognized that human populations in subSaharan Africa, but especially in South Africa, in spite of a previous profound drop in life expectancy, are aging rapidly This demographic transition is the result of falling mortality rates, due in part to widespread uptake of anti-retroviral therapy (ART), coupled with marked decreases in fertility in recent decades [1, 6, 7]. Health and social systems, and the accompanying policy processes—still contending with an “unfinished agenda” of widespread infection and excess maternal, infant and childhood illness—are poorly prepared for the scale and speed of the demographic change that is underway [8]
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