Cardiometabolic risk in a population of older adults with multiple co-morbidities in rural south africa: the HAALSI (Health and Aging in Africa: longitudinal studies of INDEPTH communities) study.
Cardiometabolic risk in a population of older adults with multiple co-morbidities in rural south africa: the HAALSI (Health and Aging in Africa: longitudinal studies of INDEPTH communities) study.
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DOI：
10.1186/s12889-017-4117-y
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发表时间：
2017-02-17
影响因子：
4.5
通讯作者：
Tollman S
中科院分区：
文献类型：
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作者：
Gaziano TA;Abrahams-Gessel S;Gomez-Olive FX;Wade A;Crowther NJ;Alam S;Manne-Goehler J;Kabudula CW;Wagner R;Rohr J;Montana L;Kahn K;Bärnighausen TW;Berkman LF;Tollman S
广泛采用抗逆转录病毒疗法（ART）的一个后果是，南非老年人口的预期寿命将增加，增加他们患心脏代谢疾病（CMD）及其危险因素的风险。在非洲人群中，HIV感染、治疗和CMD之间的长期相互作用仍有待阐明。HAALSI队列研究旨在调查这些相互作用对中老年人CMD发病率和死亡率的影响。我们招募了随机选择的40岁或40岁以上的成年人居住在农村阿金库尔分区在普马兰加省。进行面对面访谈，收集基线家庭和社会经济数据，自我报告的健康，人体测量，血压，高敏C反应蛋白（hsCRP），HbA 1c，HIV状态，以及即时血糖和血脂水平。5059人（46.4%男性）入组，平均年龄为61.7 ± 13.06岁。男性和女性的腰臀比都很高（0.92 ± 0.08 vs. 0.89 ± 0.08），70%的女性和44%的男性超重或肥胖。男性和女性的血压相似，合并高血压患病率为58.4%，随着年龄的增长观察到统计学显著性增加。女性的高总胆固醇患病率是男性的两倍（8.5%对4.1%）。自我报告的CMD疾病的患病率在女性中较高，心肌梗死除外，使用Rose标准，女性心绞痛的患病率在统计学上显著较高（10.82% vs. 6.97%）。艾滋病毒阴性者比艾滋病毒阳性者更容易患高血压、糖尿病、超重或肥胖。大约56%的队列至少有2个测量或自我报告的临床合并症，与那些没有艾滋病毒的人相比，艾滋病毒+的人有一个持续较低的患病率的合并症。根据使用的风险评分方程，女性10年心血管风险绝对评分范围为7.7-9.7%，男性为12.5-15.3%。根据传统的危险因素和新的标志物如hsCRP，该队列具有高CMD风险。队列的纵向随访将使我们能够确定在HIV感染和CMD风险均较高的人群中寿命延长的长期影响。
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. 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. We 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. Five 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. This 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.