Metabolic syndrome is associated with cardiac remodelling but not HIV status in a Zambian adult cohort

Metabolic syndrome (MetS) is an important predictor of cardiovascular disease and is becoming increasingly prevalent in sub-Saharan Africa. Although people living with HIV (PLWH) are at increased risk of cardiometabolic disorders, the independent determinants of MetS among adults with and without HIV remain incompletely understood. This study aimed to determine the prevalence of metabolic syndrome and its demographic, clinical, biochemical, and echocardiographic correlates among adults with and without HIV in Zambia. We conducted a cross-sectional study among 227 (62.6% living with HIV, all virally suppressed) attending the outpatient medical clinic at Livingstone University Teaching Hospital, Zambia. MetS was defined using International Diabetes Federation (IDF) criteria with African-specific waist circumference cut-off (≥ 94 cm men, ≥ 80 cm women), plus any two of four additional risk factors (elevated blood pressure, high triglycerides, low HDL cholesterol, and high fasting blood glucose). We measured anthropometry, metabolic parameters, cardiac structure (echocardiography), and inflammatory markers. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to identify candidate predictors for inclusion in multivariable logistic regression model. MetS prevalence was 23.8% (54/227). Participants with MetS were significantly older and had higher body mass index, fasting insulin, inflammatory biomarkers, left ventricular mass and interventricular septal diameter, while estimated glomerular filtration rate was significantly lower (all P < 0.05). After multivariable adjustment, increasing age (adjusted odds ratio [AOR] 1.04, 95% CI: 1.01–1.07; P = 0.015), female sex (AOR 2.42, 95% CI: 1.13–5.20; P = 0.023) and greater interventricular septal diameter (AOR 5.92, 95% CI: 1.13–31.10; P = 0.036) were independently associated with MetS, whereas HIV infection was not (AOR 1.28, 95% CI: 0.61–2.68; P = 0.513). Among PLWH, female sex, employment and increased interventricular septal diameter remained significantly associated with MetS, whereas age was associated with MetS only among HIV-negative participants. Nearly one-quarter of adults in this Zambian cohort had metabolic syndrome. Older age, female sex, and increased interventricular septal diameter were independently associated with MetS, while HIV infection was not an independent determinant. These findings suggest that conventional cardiometabolic risk factors and early cardiac remodeling contribute more strongly to MetS than HIV status alone. Integrated screening strategies targeting metabolic and cardiovascular risk factors should be prioritized among both PLWH and HIV-negative adults to reduce the future burden of cardiovascular disease.