With a much improved ART of the present day, most morbidities and mortalities in PLWHA has been associated with a number of factors such as NIDs (in most of the cases), especially in the form of CHD [23].
The CHD has become the major factor, limiting life expectancy, and causing death in individuals’ age 45 and above [24]. The etiology of CHD in PLWHA is multifactorial and can be caused with HIV itself but cART and predisposing genetic and environmental RFs can also be the reasons [25].
PLWHA confront high challenges to CHD due to the fact that HIV management by itself is complex and requires life time intervention [26]. Since, ASCVD & FRS are the most widely used tools for the CHD risk evaluation, both tools have overlaps of variables to determine the risks of CHD, even though there are some peculiar variations [2, 13, 26].
A number of studies have investigated that the CHD risk in PLWHA using the FRS tool and reported that the extrapolated tool was equally as important to the general population. Some recently published articles favors the use of ASCVD over FRS as a better predictive tool of CHD [2, 13, 27].
The proportion of females was higher using the FRS (56.2%) with overall mean of 43.5 ± 11.3. Whereas, using ASCVD male were predominant (54.3%). Considering the total participants, most participants were age below 40 years while using the ASCVD 50 % were in the age range b/n 40 to 49 years.
The intensity of efforts to prevent cardiovascular disease depends on the absolute risk of CHD, which is calculated using either the FRS or the ASCVD equation [28, 29]. Majority 89 (88%) of the participants in the FRS were categorized under low CHD risk, while 29 (10.1 %) had moderate and 4 (1.4 %) had high-risk for developing CHD. Our study was comparable to the rates reported by some previously conducted studies [14, 15] but it was lower than the studies conducted in Slovenia [15], Ugandia 17, and Spain [15]; and our result is higher than the Norwegian [16] and the Brazilian [30] studies. This variation in the estimation of prevalence could be due to differences in standard care, management, and level of medical care services.
In our study, nearly all women were included in the 10% or less of the 10-year FRS category, but 20% of men had 10% or more long-term risk of CHD. This was in agreement with other studies [15, 24, 26]. To give more emphasis on management, one study reported that even though the CHD was less prevalent among female geder would be more devastating and fatal if it occurs [2].
About 28% of the participants enrolled in the ASCVD group had ≥ 7.5% risks of CHD, which is considered as a more severe form of the disease. This figure was a bit higher than the study conducted in Botswana [31] and Taiwan [32] but lower than the study conducted in Italy [33] & the U.S. [18].
A number of predicators were significantly associated with the estimation of ASCVD in our study. Advanced age was associated with high risk of CHD (β = .061, p < .001). This result was comparable with a number of other studies done globally [34–36].
It is also widely accepted that male gender was prone to develop CHD than females due to a number of inherited (genetics, sex hormones) and environmental (CHD predisposing risk practices like cigarette smoking and working industrial zones) factors [37]. This evidence was in agreement with our findings that the risk was more pronounced in male gender (β = .816, p < .001). Similar findings were obtained from studies supporting our result [36, 38]. One study reported that the lifetime risk of CHD at age 40 years is 50% for men and 33.3 % for women [36].
A number of research outputs reported that hypertension is an important RF for cardiac, cerebrovascular and other form of vascular diseases [39, 40] and the occurrence of hypertension and CHD has been common [41]. In our study an increase in SBP was associated with increased risk of CHD (β = .21, p < .001), which was also comparable with other similar studies [42–44].
Dyslipidemia is considered as the most frequent RF for CHD as reported in many resources [44, 45]. In our study an increased in TC was associated with CHD (β = .002, p = .001), while a decrease in the level of HDL was also associated with increased risk of CHD (β = − .02, p < .001). This result was well balanced with other reports[46–48]. The repots further stressed that a raised TC has been a strong risk pridictor for CHD, with evidence of a small, but stronger effect in men compared to women. Increased in HDL level has been reported as a protective for CHD in many studies [46, 49].
The association of tobacco consumption with CHD have been reported in a number of scientific literatures [50, 51]. Our study revealed that cigarette smoking irrespective of duration and amount of cigarettes used, was significantly associated with the risk of CHD (β = .559, p < .001). The result was in agreement with multiple studies resources [51–53].
With respect to the FRS group, the strongest predictor was gender (OR = 26.1). Male participants had 96.3% more chance of developing CHD unlike of females. This was in line with various studies done elsewhere [24, 26, 54]. Age was also a strong predicator of CHD (OR = 1.3), indicating that for every year increment in age, the risk of acquiring CHD increased by 27%. Our study further revealed that, the overall risk of developing CHD was higher among individuals age 40 and above. This was in agreement with a number of scientific sources that stated an increased in age was associated with increased risk for CHD [24, 55–57].
Low level HDL-C was also associated with increased CHD using the FRS tool (OR = 0.877), demonstrating that for every unit of increment in the plasma HDL-C level, the chance of acquiring CHD was decreased by 13%. This was in harmony with other similar studies [58–60]. Decreased levels of HDL has been recognized as an independent risk factor for adverse cardiovascular outcomes in general population and it was also shown to be true in HIV-infected individuals, irrespective of other risk factors [61]. The protective role of HDL-C was publicized with its inverse relationship with the FRS, which once again was well-matched with the study done in Spain and in Uganda [14, 24].
Limitations Of The Study
These findings may not be representative of the entire population but can serve as a baseline to initiate further large-scale studies in PLWHA.