Risk factors and assessment for cardiovascular disease among HIV-positive patients attending a Nigerian tertiary hospital.

Ifeyinwa Dorothy Osegbe,Oyetunji Olukayode Soriyan,Elaine Chinyere Azinge,Abiola Ann Ogbenna,Henry Chima Okpara

doi:10.11604/pamj.2016.23.206.7041

Ifeyinwa Dorothy Osegbe, Oyetunji Olukayode Soriyan + Show 3 more

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https://doi.org/10.11604/pamj.2016.23.206.7041

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Abstract

IntroductionCardiovascular risk factors are prevalent in HIV-positive patients which places them at increased risk for cardiovascular disease (CVD). We aimed to determine the risk factors and risk assessment for CVD in HIV-positive patients with and without antiretroviral therapy.MethodsThis was a cross-sectional study of HIV-positive patients attending the Lagos University Teaching Hospital, Nigeria. Anthropometric and blood pressure measurements were performed; fasting lipid profile, plasma glucose, homocysteine and hsCRP were determined, as well as prevalences and risk assessments. Statistical tests were used to compare the groups and p-value <0.05 was considered to be significant.Results283 subjects were recruited for this study (100 HIV-positive treatment-naive, 100 HIV-positive treated and 83 HIV negative controls). Compared to the controls, mean (sd) values were significantly higher among HIV-treated subjects: waist circumference = 88.7 (10.4), p = 0.035; systolic bp= 124.9 (20.7), p = 0.014; glucose= 5.54 (1.7), p = 0.015; triglyceride= 2.0 (1.2), p < 0.001; homocysteine= 10.9 (8.9-16.2), p = 0.0003; while hsCRP= 2.9 (1.4-11.6), p = 0.002 and HDL-C = 0.9 (0.4), p = < 0.0001 were higher among the HIV-naïve subjects. Likewise, higher prevalences of the risk factors were noted among the HIV-treated subjects except low HDL-C (p < 0.001) and hsCRP (p = 0.03) which were higher in the HIV-naïve group. Risk assessment using ratios showed high risk for CVD especially in the HIV-naïve group. The median range for Framingham risk assessment was 1.0 - 7.5%.ConclusionRisk factors and risk assessment for CVD are increased in HIV-positive patients with and without antiretroviral therapy. Routine evaluation and risk assessment for CVD irrespective of therapy status is necessary to prevent future cardiovascular events.

Highlights

Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels which can manifest as coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, deep vein thrombosis and pulmonary embolism [1]
The mean values of CVD risk factor variables are shown in Table 1 highlighting significant differences between the 3 groups, while in Table 2 the means were compared between the controls and each subject subgroup
Risk assessment for CVD using Grover’s risk ratio Low Density Lipoprotein-Cholesterol (LDL-C)/High Density Lipoprotein-Cholesterol (HDL-C) [22] revealed mean ± sd of Human Immunodeficiency Virus (HIV) naïve 3.6 ± 2.5 and HIV treated 2.5 ± 1.4 which fall in the range of 3.3 – 3.7 that signifies increased risk of death from CVD [23]

Summary

Introduction

Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels which can manifest as coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, deep vein thrombosis and pulmonary embolism [1]. It is a primary cause of death worldwide [2] with atherosclerosis being the most common pathological process that leads to it, involving a combination of vascular endothelial dysfunction, chronic inflammation, and dyslipidaemia [3]. A variety of novel biochemical markers have been suggested to identify individuals at increased risk for CVD, such as: markers of inflammation e.g. high sensitivity C-reactive protein (hsCRP)[5], Homocysteine [6,7,8], markers of fibrinolytic and haemostatic function e.g. tissue type plasminogen activator antigen and fibrinogen respectively [9]

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