Lung function and atherosclerosis: a cross-sectional study of multimorbidity in rural Uganda

BMC Pulmonary Medicine

June-Ho Kim¹  Isabelle T. Yang²  Rebecca F. Gilbert³  Cody Cichowitz³  Linda C. Hemphill⁴  Crystal M. North⁴  David C. Christiani⁵  Mark J. Siedner⁶  Alexander C. Tsai⁶  Bernard Kakuhikire⁷  Ruth N. Sentongo⁷  Prossy Bibangambah⁷  Samson Okello⁷ 

[1] Brigham and Women’s Hospital, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Geisel School of Medicine at Dartmouth, Hanover, NH, USA;Massachusetts General Hospital, 55 Fruit Street, BUL-148, 02114, Boston, MA, USA;Massachusetts General Hospital, 55 Fruit Street, BUL-148, 02114, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Massachusetts General Hospital, 55 Fruit Street, BUL-148, 02114, Boston, MA, USA;Harvard TH Chan School of Public Health, Boston, MA, USA;Massachusetts General Hospital, 55 Fruit Street, BUL-148, 02114, Boston, MA, USA;Mbarara University of Science and Technology, Mbarara, Uganda;Harvard Medical School, Boston, MA, USA;Mbarara University of Science and Technology, Mbarara, Uganda;

关键词: COPD;    Cardiovascular disease;    HIV infection;    FEV;    cIMT;    Uganda;   

DOI  :  10.1186/s12890-021-01792-0

来源: Springer

【 摘 要 】

BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of global mortality. In high-income settings, the presence of cardiovascular disease among people with COPD increases mortality and complicates longitudinal disease management. An estimated 26 million people are living with COPD in sub-Saharan Africa, where risk factors for co-occurring pulmonary and cardiovascular disease may differ from high-income settings but remain uncharacterized. As non-communicable diseases have become the leading cause of death in sub-Saharan Africa, defining multimorbidity in this setting is critical to inform the required scale-up of existing healthcare infrastructure.MethodsWe measured lung function and carotid intima media thickness (cIMT) among participants in the UGANDAC Study. Study participants were over 40 years old and equally divided into people living with HIV (PLWH) and an age- and sex-similar, HIV-uninfected control population. We fit multivariable linear regression models to characterize the relationship between lung function (forced expiratory volume in one second, FEV1) and pre-clinical atherosclerosis (cIMT), and evaluated for effect modification by age, sex, smoking history, HIV, and socioeconomic status.ResultsOf 265 participants, median age was 52 years, 125 (47%) were women, and 140 (53%) were PLWH. Most participants who met criteria for COPD were PLWH (13/17, 76%). Median cIMT was 0.67 mm (IQR: 0.60 to 0.74), which did not differ by HIV serostatus. In models adjusted for age, sex, socioeconomic status, smoking, and HIV, lower FEV1 was associated with increased cIMT (β = 0.006 per 200 mL FEV1 decrease; 95% CI 0.002 to 0.011, p = 0.01). There was no evidence that age, sex, HIV serostatus, smoking, or socioeconomic status modified the relationship between FEV1 and cIMT.ConclusionsImpaired lung function was associated with increased cIMT, a measure of pre-clinical atherosclerosis, among adults with and without HIV in rural Uganda. Future work should explore how co-occurring lung and cardiovascular disease might share risk factors and contribute to health outcomes in sub-Saharan Africa.

【 授权许可】

CC BY