A longitudinal cohort study to evaluate cardiovascular risk factors and disease in Haiti - 2

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ABSTRACT: Cardiovascular disease (CVD) is the leading cause of death globally, with 80% of the burden in low- and middle-income countries (LMICs). Yet, the epidemiology of CVD in LMICs is poorly understood given the absence of population-based local data. In 2018, we established the Haiti CVD Cohort (HL143788), the first population-based longitudinal CVD cohort in the region to estimate the prevalence of adjudicated CVD risk factors, diseases, and their association with poverty-related social and environmental determinants. We successfully enrolled 3,005 Haitians and found: environmental (HF), national 1) 30.4% had hypertension (HTN); 2) stress, high salt diet, and lead exposure were associated with increased blood pressure; and 3) 11.6% had heart failure with higher rates among adults <40 years ( This data has informed HTN guidelines and interventions for CVD treatment. 4.5% in Haiti vs 0.3% in the US). With renewal of this R01, we can extend follow- up of this well-characterized cohort to ~22,000 PY to capture critically important incidence data spanning risk factors, events, and poverty-related determinants needed to inform CVD prevention. We will estimate incidence rates across strata and identify high-risk subgroups and population-level modifiable factors that can be targets for future evidence-based CVD prevention. This study is uniquely positioned to address hypotheses specific to CVD in LMICs and among young Black populations, where data in the US is sparse. We hypothesize uncontrolled HTN increases risk for incident HF in young adults, and environmental lead and high dietary salt are major population-level modifiable factors associated with incident CVD. Our Specific Aims are: 1. Determine the 7-year incidence of CVD risk factors and adjudicated events in the Haiti CVD Cohort. CVD risk factors include HTN, diabetes, obesity, hyperlipidemia, kidney disease, poor diet, smoking, physical inactivity, and inflammation. CVD events include HF, stroke, transient ischemic attack, angina, myocardial infarction, and CVD mortality. 2. Identify predictors of incident CVD risk factors and events, including poverty-related social and environmental determinants. We will identify modifiable predictors and high-risk subgroups for future individual-level interventions, with power to detect minimal HRs ≥1.2 across exposures with 10-50% prevalence. We will identify population-level modifiable factors using population attributable risks. 3. Characterize the local context to identify optimal implementation strategies for future evidence- based interventions to prevent CVD at the individual and population level. We will use mixed methods including multisector qualitative interviews and surveys to understand the contextual factors influencing the implementation of future interventions targeting quantitative data in Aims 1-2. This research is essential for fighting the CVD epidemic in LMICs, is enthusiastically supported by the Haitian Ministry of Health, and will inform our understanding of CVD health disparities in the 21st century.