Abstract 4359851: Low prevalence of coronary and thoracic aortic calcium in high-cardiometabolic risk Kenyan adults with and without HIV: The ASANTE Study

Abstract

Background: HIV is thought to be an independent risk factor for atherosclerotic cardiovascular disease (ASCVD), including coronary atherosclerosis, based on studies from high-income countries. However, there are limited data on the epidemiology of atherosclerosis from sub-Saharan Africa, where there is a high burden of HIV. Methods: Early Structural Cardiovascular Disease, HIV, and Tuberculosis in East Africa (ASANTE) is an ongoing cross-sectional study evaluating coronary atherosclerosis in Kenyan adults with chronically treated/suppressed HIV (PWH) and HIV-uninfected controls. We enroll participants > 45 years old with > 1 cardiometabolic risk factor (hypertension, diabetes, dyslipidemia, smoking, overweight/obesity), targeting a sample of n = 200 (50% female, 50% PWH). Participants undergo comprehensive exposure assessments and non-contrast cardiac CT. We quantify coronary artery calcium (CAC) as a measure of coronary atherosclerosis, thoracic aortic calcium (TAC), and valvular calcium using Agatston scores . We report interim results on clinical characteristics, CAC, TAC, and valvular calcium. We also compare CAC prevalence and estimated 10-year ASCVD risk in ASANTE to other published geographic cohorts. Results: We included 52 PWH and 37 HIV-uninfected control participants who completed CT imaging in this analysis ( Table 1 ). The mean age among all participants was 57 years, and 48% were female. The mean 10-year ASCVD risk score was 12.6% (10.2% in PWH, 17% in controls). Prevalence of diabetes and statin therapy for hyperlipidemia was higher among controls (p < 0.01), while low-density lipoprotein levels were higher among PWH (p = 0.003). Prevalence of CAC >0 by Agatston score was 18% (15% in PWH, 22% in controls; p = 0.63). Prevalence of CAC scores by category are shown in Figure 1 . Valvular and thoracic aortic calcium prevalence was lower than CAC, ranging from 2% to 8% among all participants. Despite having high mean 10-year cardiovascular risk, ASANTE participants had lower CAC prevalence compared with lower-risk cohorts in the United States (p = 0.02 and p <0.001 for ASANTE vs. USA-CAC Consortium and ASANTE vs. USA-SoCal, respectively; Figure 2 ). Conclusion: Despite enriching for cardiovascular risk factors, CAC is less common in the East African population, regardless of HIV status, compared with lower-risk cohorts in high-income settings. Further studies are needed to identify potential atheroprotective exposures and mechanisms in this region.