The Haiti cardiovascular disease cohort: study protocol for a population-based longitudinal cohort

Vanessa Rouzier,Jean Lookens,Grace Seo,C. Ray Smith ,Raynold Jean Baptiste,Inddy Joseph,Fabyola Preval,Joscar Victor,Monika M. Safford ,Stephano St Preux,Wilson Ariste,Olga Tymejczyk,Vanessa Rivera,Marie Marcelle Deschamps,Margaret L. Mcnairy ,Sandra Apollon,Emelyne Dumont,Patrice Sévère ,Denis Nash,Daniel W. Fitzgerald ,Jean William Pape ,Jessy G. Dévieux ,Guyrlaine Pierre Louis Forestal ,Serena P. Koenig ,Justin R Kingery ,Benedict Charles

doi:10.1186/s12889-020-09734-x

Abstract

BackgroundCardiovascular disease (CVD) is the leading cause of mortality among Haitians, having surpassed HIV in the last decade. Understanding the natural history of CVD in Haitians, including the age of onset, prevalence, incidence, and role of major risk factors and social determinants, is urgently needed to develop prevention and treatment interventions.Aim 1: Establish a population-based cohort of 3000 adults from Port-au-Prince and assess the prevalence of CVD risk factors and diseases and their association with social and environmental determinants.Aim 2: Determine the incidence of CVD risk factors and CVD during 2–3.5 years of follow-up and their association with social and environmental determinants.MethodsThe Haiti CVD Cohort is a longitudinal observational study of 3000 adults > 18 years in Port-au-Prince (PAP), Haiti. The study population is recruited using multistage random sampling from census blocks. Adults receive blood pressure (BP) measurements in the community and those with elevated BP are referred to the Groupe Haitien d’Etude Sarcome de Kaposi et des Infections Opportunistes Clinic for care. After informed consent, participants undergo a clinical exam with medical history. BP, electrocardiogram, echocardiogram, a study questionnaire on health behaviors, and laboratory specimens. Every 6 months, BP is remeasured. At 12 and 24 months, clinical exams and questionnaires are repeated. Labs are repeated at 24 months. Adjudicated study outcomes include the prevalence and incidence of CVD risk factors (hypertension, diabetes, obesity, dyslipidemia, kidney disease, inflammation, poor diet, smoking, and physical inactivity) and events (myocardial infarction, heart failure, stroke, and CVD mortality). We also measure social determinants including poverty. Depression, stress, social isolation, food insecurity, and lead exposure. Blood, urine, and stool samples are biobanked at study enrollment.DiscussionThe Haiti CVD Cohort is the largest population-based cohort study evaluating CVD risk factors and CVD among adults in urban Haiti with the goal of understanding the drivers of the CVD epidemic in Haiti. Study outcomes are comparable with existing international cohorts, and the biobank will provide important data for future research. Our goal is to translate findings from this study into pragmatic prevention and treatment interventions to fight the CVD epidemic in Haiti.

Highlights

Cardiovascular disease (CVD) is the leading cause of mortality among Haitians, having surpassed HIV in the last decade
With CVD being the largest driver of global mortality, the World Health Organization (WHO) has ambitiously targeted a one-third reduction in premature deaths from CVD and other noncommunicable diseases by 2025 [11, 12]
Prevalence of CVD risk factors will be reported for categorical risk factors (e.g., HTN), and mean and standard deviation will be estimated for continuous risk factors (e.g., blood pressure (BP), lipid levels)

Summary

Introduction

Cardiovascular disease (CVD) is the leading cause of mortality among Haitians, having surpassed HIV in the last decade. Aim 1: Establish a population-based cohort of 3000 adults from Port-au-Prince and assess the prevalence of CVD risk factors and diseases and their association with social and environmental determinants. In 2017, the World Health Organization (WHO) reported that CVD is “the number one cause of death globally” [5] This emerging CVD epidemic in resource-poor settings is likely due to an increase in traditional CVD risk factors, such as smoking, hypertension (HTN), and diabetes, as well as other social and environmental determinants such as poverty, stress, social isolation, depression, the effect of food insecurity on dietary habits, and environmental lead exposure [6,7,8,9,10]. Our data from a smaller community-based survey of slum residents in Port-au-Prince (PAP) in 2016 found the prevalence of HTN among young Haitians was higher than similar aged Blacks in the US from historical cohort studies [16, 17]

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