Key result
Higher SBP linked to ~5% higher odds of abnormal echocardiograms in adults with HIV.
Why the study?
There are limited data on structural heart disease among people living with HIV in southern Africa despite prevalent cardiovascular risk factors and improved life expectancy with ART.
Cross-Sectional (n=202)
Odds Ratio: 1.05 (95% CI 1.03–1.08)
Left ventricular hypertrophy is common among adults living with HIV on ART in Malawi and is independently associated with elevated blood pressure and BMI.
LVH prevalence signals hypertension control gaps in Malawian HIV care; leaves open whether echocardiography screening improves outcomes.
BACKGROUND: There are limited data on structural heart disease among people living with HIV in southern Africa, where the success of antiretroviral therapy (ART) has drastically improved life expectancy and where risk factors for cardiovascular disease are prevalent. METHODS: We performed a cross-sectional study of screening echocardiography among adults (≥18 years) with HIV in Malawi presenting for routine ART care. We used univariable and multivariable logistic regression to evaluate correlates of abnormal echocardiogram. RESULTS: A total of 202 individuals were enrolled with a median age of 45 years (IQR 39-52); 52% were female, and 27.7% were on antihypertensive medication. The most common clinically significant abnormality was left ventricular hypertrophy (LVH) (12.9%, n=26), and other serious structural heart lesions were rare (<2% with ejection fraction less than 40%, moderate-severe valve lesions or moderate-severe pericardial effusion). Characteristics associated with abnormal echocardiogram included older age (OR 1.04, 95% CI 1.01 to 1.08), higher body mass index (OR 1.09, 95% CI 1.02 to 1.17), higher mean systolic blood pressure (OR 1.03, 95% CI 1.02 to 1.05) and higher mean diastolic blood pressure (OR 1.03, 95% CI 1.01 to 1.05). In a multivariable model including age, duration on ART, body mass index, and systolic and diastolic blood pressure, only mean body mass index (adjusted OR 1.10, 95% CI 1.02 to 1.19), systolic blood pressure (aOR 1.05, 95% CI 1.03 to 1.08) and diastolic blood pressure (aOR 0.96, 95% CI 0.92 to 1.00) remained associated with abnormal echocardiogram. CONCLUSIONS: LVH was common in this population of adults on ART presenting for routine care and was associated with elevated blood pressure. Further research is needed to characterise the relationship between chronic hypertension, LVH and downstream consequences, such as diastolic dysfunction and heart failure in people living with HIV.
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Hoffman et al. (2022) conducted a cross-sectional in HIV (n=202). Higher systolic blood pressure was evaluated on Abnormal echocardiogram (aOR 1.05, 95% CI 1.03-1.08). Left ventricular hypertrophy was present in 12.9% of adults with HIV on ART, and abnormal echocardiograms were associated with higher systolic blood pressure (aOR 1.05; 95% CI 1.03-1.08).
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