Abstract
BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of global mortality. In high-income settings, the presence of cardiovascular disease among people with COPD increases mortality and complicates longitudinal disease management. An estimated 26 million people are living with COPD in sub-Saharan Africa, where risk factors for co-occurring pulmonary and cardiovascular disease may differ from high-income settings but remain uncharacterized. As non-communicable diseases have become the leading cause of death in sub-Saharan Africa, defining multimorbidity in this setting is critical to inform the required scale-up of existing healthcare infrastructure.MethodsWe measured lung function and carotid intima media thickness (cIMT) among participants in the UGANDAC Study. Study participants were over 40 years old and equally divided into people living with HIV (PLWH) and an age- and sex-similar, HIV-uninfected control population. We fit multivariable linear regression models to characterize the relationship between lung function (forced expiratory volume in one second, FEV1) and pre-clinical atherosclerosis (cIMT), and evaluated for effect modification by age, sex, smoking history, HIV, and socioeconomic status.ResultsOf 265 participants, median age was 52 years, 125 (47%) were women, and 140 (53%) were PLWH. Most participants who met criteria for COPD were PLWH (13/17, 76%). Median cIMT was 0.67 mm (IQR: 0.60 to 0.74), which did not differ by HIV serostatus. In models adjusted for age, sex, socioeconomic status, smoking, and HIV, lower FEV1 was associated with increased cIMT (β = 0.006 per 200 mL FEV1 decrease; 95% CI 0.002 to 0.011, p = 0.01). There was no evidence that age, sex, HIV serostatus, smoking, or socioeconomic status modified the relationship between FEV1 and cIMT.ConclusionsImpaired lung function was associated with increased cIMT, a measure of pre-clinical atherosclerosis, among adults with and without HIV in rural Uganda. Future work should explore how co-occurring lung and cardiovascular disease might share risk factors and contribute to health outcomes in sub-Saharan Africa.
Highlights
Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality
In sub-Saharan Africa, an estimated 26 million people are living with COPD [7] and one million people die from cardiovascular disease each year [8], yet little is known about the prevalence, risk factors, or health outcomes of concomitant cardiovascular disease among those with lung disease in the region
Data from high income settings suggest that chronic Human immunodeficiency virus (HIV) infection independently increases the risk of both COPD and cardiovascular disease [19, 20], and while relationships between HIV and COPD seem to be similar in African populations [21,22,23,24], emerging data suggests that people living with HIV (PLWH) in sub-Saharan Africa may have a different cardiovascular disease risk profile than their counterparts in high income settings [25, 26]
Summary
Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality. In high-income settings, the presence of cardiovascular disease among people with COPD increases mortality and complicates longitudinal disease management. An estimated 26 million people are living with COPD in sub-Saharan Africa, where risk factors for co-occurring pulmonary and cardiovascular disease may differ from high-income settings but remain uncharacterized. Smoking is less prevalent in many regions of sub-Saharan Africa as compared to high-income settings [13, 14], and how this influences risk of concomitant lung and cardiovascular disease remains to be seen. Air pollution—the greatest environmental threat to health—is causally associated with both lung and cardiovascular disease [15], is more prevalent across sub-Saharan Africa as compared to high income settings [16], and may further heighten the risk of cardiovascular disease mortality among people with COPD [17]. HIV may influence relationships between lung and cardiovascular disease risk differently in HIV endemic regions, but these patterns and their implications for disease prevalence and health outcomes have not been well-characterized
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