Coronary artery disease in Uganda patients with HIV is rare

Ugandan HIV patients have less prevalence of coronary artery disease than those without HIV. Among both groups, the prevalence of coronary artery disease was lower compared to European and North American populations, last week, Conference on Retroviruses and Opportunistic Infections (CROI 2025) At a San Francisco show.

Findings suggest that statins are given as a measure to prevent heart disease in people with HIV at low to moderate risk of heart disease It may not be prioritized in the African population.

Studies in high-income countries consistently show that people with HIV are at a higher risk of cardiovascular disease than other populations. However, few studies have seen cardiovascular disease in HIV patients in Africa, where the majority of HIV live.

A large international study reported in 2023 that daily use of pitavastatin by people with HIV has been reported in 2023 We reduced the risk of major cardiovascular events such as stroke and heart attacks by 36% in people deemed at low to moderate risk of heart disease. However, this study found that risk reduction varies across regions around the world, and the effects of statin treatment were not statistically significant in participants from high-income countries and outside of South Asia. This is probably explained by the small number of cardiovascular events recorded in these regions.

Dr. Mark Sydner of Harvard University presented the results of the Uganda coronary artery disease study. It was designed to investigate the prevalence of coronary artery disease in people over the age of 40 in Uganda.

This study recruited 287 adults with antiretroviral treatment for at least 3 years to undergo screening for coronary artery disease and 299 HIV-negative controls for age and gender. All participants underwent CT scans to measure calcium levels and coronary CT angiography to measure plaque within the coronary artery.

The average age of the study participants was 57 years old, with 49% being female, and 95% of people with HIV suppressed viral load. Only two-thirds (63%) of people with HIV were agricultural workers.

The median 10-year risk score for ASCVD (atherosclerotic cardiovascular disease) was 3.4% for people with HIV and 4.1% for people without HIV, indicating a population at a lower risk of developing cardiovascular disease. Risk scores are calculated based on age, gender, blood pressure, cholesterol, history of diabetes, smoking history, cholesterol lowering and blood pressure medication use.

This study found that 9.1% of people with HIV and 6.4% of people without HIV had coronary artery disease, with a non-significant difference. The prevalence of coronary artery disease was slightly higher in people with HIV at all levels of predicted cardiovascular risk, but these differences were not statistically significant.

The prevalence of coronary artery disease seen in this rural population in Uganda is much lower than that observed in other regions. A recent large-scale general population study found a prevalence of approximately 50% in the US, 40% in Sweden, and 20% in South Korea.

The Uganda Coronary Artery Disease Research Research Group is working to compare cardiovascular risks between rural and urban populations in Uganda. “The amount of activity reported by this group is about ten times as much as the average US report. They work hard every day to provide self-sufficiency to their families, and we can't help but think that subsistence farmers are contributing to increased health in terms of coronary artery disease,” said Siedner.

Dr. Roger Bedimo, PhD at the University of Texas Southwestern Medical Services, asked how African clinicians should use a cardiovascular risk model, given that risk in sub-Saharan Africa reduces the risks that were overly predicted in generous studies.

“Our findings highlight the importance of local data,” replied Dr. Siedner. “There's a lot of data to collect to build predictive models.”

“We need to develop regionally specific scores in sub-Saharan Africa,” said Professor Stephen Grinspoon, principal investigator of the Grace Study.