Assessment of cardiovascular health using the "Life's Simple 7" among the Canadian HIV and Aging Cohort study participants: a cross-sectional observational study


BACKGROUND: There is growing evidence that cardiovascular diseases (CVD) disproportionately affect people living with HIV (PLHIV). However, little is known about overall cardiovascular health among PLHIV.
METHODS: We assessed the American Heart Association (AHA)'s 'Life''s Simple 7' (LS7) metrics (smoking, body mass index, diet, physical activity, total cholesterol, blood pressure, blood glucose) among Canadian HIV and Aging Cohort Study, CTN 272 (CHACS) participants who completed a validated web-based food-frequency questionnaire (web-FFQ). LS7 metrics were dichotomized using a set of "ideal" cutoffs recommended by the AHA to yield an overall LS7 score ranging from 0 to 7 points. Robust Poisson regressions were used to assess the associations between HIV status and the LS7 metrics, and between HIV status and LS7 diet submetrics (fruits/vegetables, fish, fiber-rich whole grain, sugar-sweetened beverages). Analyses were adjusted for age, sex, ethnic background, education, and annual income. Effect modification by sex was also assessed.
RESULTS: A total of 279 CHACS participants (73% PLHIV) completed the web-FFQ at a median of 55 months (interquartile range [IQR]=40-64) of follow-up. Median age was 59 years (IQR=55-66), and most participants were male (82%) and White (87%). The distribution of the LS7 score was similar between PLHIV and HIV-negative groups with a median score of 3 (IQR=2-4). No participant had an ideal cardiovascular health score of 7. The LS7 metrics with the highest and lowest prevalence of ideal score overall were blood glucose (70%) and diet (0.4%), respectively. Female PLHIV were over 6 times more likely to not smoke tobacco compared to HIV-negative female participants (adjusted proportions ratio [aPR]=6.54, 95% confidence interval [95%CI]: 1.66-25.76) and less likely to have ideal blood glucose concentration (aPR=0.75, 95%CI: 0.57-0.99). Among males, PLHIV were less likely to have an ideal total cholesterol concentration compared to HIV-negative participants (aPR=0.66, 95%CI: 0.48-0.91). No statistically significant difference was observed between PLHIV and HIV-negative participants in the proportions of ideal scores for diet submetrics.
CONCLUSIONS: Our study highlights overall poor cardiovascular health among PLHIV and HIV-negative CHACS participants alike. Further public health efforts among adults aged '¥40 years are urgently needed and should focus on behavioural risk factors for CVD.

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