Anthropometric measures and their association with risk factors for cardio-metabolic diseases in Kenyan adults

Background: The prevalence of cardio-metabolic diseases (CMD) is drastically increasing worldwide. Anthropometric measures of fat accumulation are correlated with CMD and Metabolic Syndrome (MS), but few studies have addressed this association in sub-Saharan African populations.

Aim: To investigate the association between anthropometric features, MS and other CMD risk factors in a population from Kenya.

Subjects and methods: In this cross-sectional study including 1405 Kenyans, anthropometric measurements including visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) were carried out. Fasting blood glucose and standard oral glucose tolerance test, fasting serum insulin and plasma lipids were analysed. Homeostatic model assessment of insulin resistance was calculated. Systolic and diastolic blood pressures were measured.

Results: CMD risk factors and MS were associated with all anthropometric features, except for high-density lipoprotein cholesterol levels (p?<?0.05). The strongest association between MS and anthropometrics was seen with SAT (β?=?1.45?±?0.32 in men and 0.88?±?0.14 in women, both p?<?0.05).

Conclusions: Anthropometric measures, especially features of central obesity such as VAT and SAT, are relevant indicators of cardio-metabolic health in Kenyan populations. SAT is the strongest predictor of MS. These results highlight the need for further research on the pathological implication of VAT and SAT, in order to understand patterns of fat distribution and cardio-metabolic health among different ethnic groups.     

Ethnic differences in low-density lipoprotein particle size in hypertensive adults

BackgroundHypertensive African Americans have higher rates of coronary heart disease (CHD) than their non-Hispanic white counterparts, despite having higher high-density lipoprotein cholesterol (HDL-C) levels and lower triglyceride levels.ObjectiveThe goal of the present study was to assess whether low-density lipoprotein (LDL) particle size, a correlate of the above lipid traits and a risk factor for CHD, differs between hypertensive African Americans and whites.MethodsParticipants included 1,177 hypertensive African Americans from Jackson, MS (60 ± 7 years, 72.4% women) and 860 hypertensive whites from Rochester, MN (58 ± 7 years, 56.7% women). LDL particle size was measured by polyacrylamide gradient gel electrophoresis. Within each gender, we assessed whether ethnicity was significantly associated with differences in LDL particle size after adjustment for CHD risk factors (age, total cholesterol, HDL-C, triglycerides, systolic blood pressure, diabetes, history of smoking, body mass index), statin use, and estrogen use (in women), and lifestyle variables (physical activity and alcohol intake).ResultsAlthough HDL-C levels were higher and triglyceride levels lower in African Americans, LDL particle size (adjusted for CHD risk factors) was lower (P < 0.0001) in African-American men and women than in their white counterparts (mean ± SD; men, 267.6 ± 5.2 Å vs 270.2 ± 4.8 Å; women 268.7 ± 5.1 Å vs 271.3 ± 5.1 Å). In both genders, African-American ethnicity was associated with lower LDL particle size after adjustment for CHD risk factors, statin use and estrogen use (in women), as well as physical activity and alcohol intake.ConclusionHypertensive African-American men and women have lower LDL particle size than their white counterparts, despite having higher HDL-C and lower triglycerides.     

Lipid Changes in Patients Initiating Efavirenz- and Indinavir-Based Antiretroviral Regimens

Abstract

Purpose: To evaluate nonfasting lipid levels in a large cohort of patients on three HAART regimens: efavirenz + zidovudine + lamivudine (EFV+ZDV+3TC), efavirenz + indinavir (EFV+IDV), and indinavir + zidovudine + lamivudine (IDV+ZDV+3TC). Method: Nonfasting lipid levels were analyzed from a large randomized multicenter treatment trial for HIV-infected patients initiating HAART. Treatment evaluations were carried out at prescribed intervals, and data were recorded and analyzed. Assessment was limited to high-density lipoprotein (HDL) and total cholesterol. Results: The results demonstrate an increase in the total cholesterol, ranging from 23 to 57 mg/dL, in the three combinations of HAART therapy. The increase was most significant in the EFV+IDV arm where the effects appear to be additive. HDL cholesterol also increased in all three arms, but the greatest increase was in the two groups containing EFV. In all three arms, the HDL cholesterol increased significantly in women while increases in men were seen only in the EFV-containing arms. Men taking either IDV-containing regimen had a greater increase in total cholesterol, and therefore the total/HDL cholesterol ratio rose significantly. Conclusion: EFV and IDV independently elevate lipid levels. Alterations in the lipid levels may lead to increased cardiovascular risk in men, possibly mitigated by elevations in HDL cholesterol. In addition, changes in HDL cholesterol were significantly different between men and women.     

Caregiving and cardiovascular disease risk factors in male and female Luo elders from Kenya

Background: The HIV/AIDS pandemic has created over 11 million orphans, who are primarily being cared for by grandparents. It has been suggested that this renewed parenting responsibility presents elders with added stressors. Few studies have systematically examined the impact of caregiving on health outcomes.

Aim: The aim of this study was to examine the impact of caregiving on cardiovascular risk. It was hypothesized that caregiving would increase cardiovascular disease risk as measured by Framingham risk scores.

Subjects and method: 386 Luo elders (age = 73±8), divided into caregiving and non-caregiving groups, were recruited from the Nyanza Province, Kenya. Data were obtained from the participants including: Total cholesterol, HDL cholesterol, glucose, blood pressure, age, sex and smoking status.

Results: No significant difference was found between the Framingham risk scores of caregivers and non-caregivers. Among women increased BMI was positively associated with Framingham score (p=0.017), and among men increased waist circumference was positively associated with the score (p<0.001). Among women, the number of orphans under one's care lowered the risk of falling into the top quartile of the Framingham score while being a caregiver increased the risk of falling into the top quartile.

Conclusion: This study demonstrates that there is not a simple relationship between caregiving and cardiovascular risk.     

Appropriate BMI cut-off values for identification of metabolic risk factors: Third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007)

Aim: To determine the appropriate threshold of body mass index (BMI) associated with increased risk of cardiovascular diseases in a large representative sample of an Iranian population.

Subjects and methods: Data of third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007) were used in this study. Sensitivity, specificity, and shortest distance on the receiver-operating characteristic (ROC) curves were used to determine gender-specific optimal cut-offs of BMI for cardiometabolic risk factors including elevated blood pressure, low high-density lipoprotein cholesterol, high triglycerides, high fasting plasma glucose and for ≥ 2 of the aforementioned risk factors.

Results: There was a continuous increase in the prevalence of cardiometabolic risk factors with increasing BMI (p < 0.001). At the BMI of 25–29 kg/m² men were at higher risk of cardiovascular diseases compared to women (p < 0.001). The appropriate BMI cut-offs ranged from 24.6–26.1 kg/m² for men and from 26.9–28.8 kg/m² for women. The optimal BMI cut-offs for identifying any two or more of those risk factors were 25.2 and 27.3 kg/m² in men and women, respectively.

Conclusion: In men the appropriate BMI cut-offs are ～25 kg/m², while in women higher BMI values are associated with risk of cardiovascular diseases.     

Adiponectin levels are associated with coronary artery disease across Caucasian and African-American ethnicity

The hypothesis was tested that plasma levels of adiponectin would be associated with coronary artery disease (CAD) across African-American and Caucasian ethnicity and gender. Adiponectin levels, cardiovascular risk factors, and extent of CAD were measured in 453 subjects (173 African-American and 280 Caucasian men and women). The distribution of adiponectin levels differed significantly between African-Americans and Caucasians (P<0.0001). Among African-Americans, the adiponectin distribution was skewed toward lower levels. For women, adiponectin levels were higher among Caucasians compared with African-Americans (P<0.001), whereas no interethnic difference was observed for men. Irrespective of ethnic group, subjects with CAD had lower levels of adiponectin than did subjects without CAD. Adiponectin was negatively and significantly associated with waist-hip ratio, body mass index, diastolic blood pressure, insulin level, and homeostasis model assessment-insulin resistance in both ethnic groups. Among lipid parameters, total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels were negatively correlated with adiponectin, whereas the high-density lipoprotein cholesterol level correlated positively for both African-Americans and Caucasians. In a multiple regression model, controlling for gender, ethnicity, and other CAD risk factors, adiponectin levels were negatively associated with CAD (P<0.05). The results indicate that, across gender and ethnicity, low adiponectin levels may be an independent risk factor for CAD.     

Cholesterol, triglycerides, and the Five-Factor Model of personality

Unhealthy lipid levels are among the leading controllable risk factors for coronary heart disease. To identify the psychological factors associated with dyslipidemia, this study investigates the personality correlates of cholesterol (total, LDL, and HDL) and triglycerides. A community-based sample (N = 5532) from Sardinia, Italy, had their cholesterol and triglyceride levels assessed and completed a comprehensive personality questionnaire, the NEO-PI-R. All analyses controlled for age, sex, BMI, smoking, drinking, hypertension, and diabetes. Low Conscientiousness and traits related to impulsivity were associated with lower HDL cholesterol and higher triglycerides. Compared to the lowest 10%, those who scored in top 10% on Impulsivity had a 2.5 times greater risk of exceeding the clinical threshold for elevated triglycerides (OR = 2.51, CI = 1.56-4.07). In addition, sex moderated the association between trait depression (a component of Neuroticism) and HDL cholesterol, such that trait depression was associated with lower levels of HDL cholesterol in women but not men. When considering the connection between personality and health, unhealthy lipid profiles may be one intermediate biomarker between personality and morbidity and mortality.     

Cardiorespiratory fitness and physical activity in Luo,Kamba, and Maasai of rural Kenya

Background:

Although habitual physical activity energy expenditure (PAEE) and cardio‐respiratory fitness (CRF) are now well‐established determinants of metabolic disease, there is scarcity of such data from Africa. The aim of this study was to describe objectively measured PAEE and CRF in different ethnic populations of rural Kenya.

Methods:

A cross‐sectional study was done among 1,099 rural Luo, Kamba, and Maasai of Kenya. Participants were 17–68 years old and 60.9% were women. Individual heart rate (HR) response to a submaximal steptest was used to assess CRF (estimated VO₂max). Habitual PAEE was measured with combined accelerometry and HR monitoring, with individual calibration of HR using information from the step test.

Results:

Men had higher PAEE than women (～78 vs. ～67 kJ day^?1 kg^?1, respectively). CRF was similar in all three populations (～38 and ～43 mlO₂·kg^?1 min^?1 in women and men, respectively), while habitual PAEE measures were generally highest in the Maasai and Kamba. About 59% of time was spent sedentary (<1.5 METs), with Maasai women spending significantly less (55%). Both CRF and PAEE were lower in older compared to younger rural Kenyans, a difference which was most pronounced for PAEE in Maasai (?6.0 and ?11.9 kJ day^?1 kg^?1 per 10‐year age difference in women and men, respectively) and for CRF in Maasai men (?4.4 mlO₂·min^?1 kg^?1 per 10 years). Adjustment for hemoglobin did not materially change these associations.

Conclusion:

Physical activity levels among rural Kenyan adults are high, with highest levels observed in the Maasai and Kamba. The Kamba may be most resilient to age‐related declines in physical activity. Am. J. Hum. Biol. 2012. © 2012 Wiley Periodicals, Inc.

     

Cardiovascular Risk: Gender Differences in Lifestyle Behaviors and Coping Strategies

Background

Although cardiovascular disease (CVD) does not occur until mid to late life for most adults, the presence of risk factors, such as high blood pressure (BP) and cholesterol, has increased dramatically in young adults.

Purpose

The present study examined the relationships between gender and coping strategies, lifestyle behaviors, and cardiovascular risks.

Method

The sample consisted of 297 (71% female) university students. Participants completed a survey to assess demographics, lifestyle behaviors, and coping strategies, and a physiological assessment including lipid and blood pressure (BP) measurements. Data collection occurred from January 2007 to May 2008.

Results

Analyses revealed that age, ethnicity, greater body mass index (BMI), greater use of social support, and less frequent exercise were associated with higher cholesterol, while gender, age, greater BMI, and less frequent exercise were associated with higher systolic BP. There were two significant interactions: one between gender and avoidant coping and the other between gender and exercise on systolic BP, such that for men greater use of avoidant coping or exercise was associated with lower systolic BP.

Conclusion

Understanding how young adults manage their demands and cope with stress sets the stage for understanding the developmental process of CVD. Both coping strategies and lifestyle behaviors must be considered in appraising gender-related cardiovascular risk at an early age before the disease process has begun.     

HIV and coronary artery calcium score: comparison of the Hawaii Aging with HIV Cardiovascular Study and Multi-Ethnic Study of Atherosclerosis (MESA) cohorts

Objectives:

To determine the association of HIV, immunologic, and inflammatory factors on coronary artery calcium (CAC), a marker of subclinical atherosclerosis.

Methods:

Cross-sectional study comparing baseline data of males from Hawaii Aging with HIV – Cardiovascular Study (HAHCS) with the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. The cohorts were pooled to determine effects of HIV on CAC and explore immunologic and inflammatory factors that may explain development of CAC in HIV. Multivariable regression models compared CAC prevalence in HAHCS with MESA adjusting for coronary heart disease (CHD) risk profiles.

Results:

We studied 100 men from HAHCS and 2733 men from MESA. Positive CAC was seen in 58% HAHCS participants and 57% MESA participants. Mean CAC was 260.8 in HAHCS and 306.5 in MESA. Using relative risk (RR) regression, HAHCS participants had a greater risk (RR?=?1.20, P?Discussion:

HIV was independently associated with a positive CAC in men with increased likelihood occurring between 45 and 50?years of age. Current HIV viral load, CD4 count, length of HIV, and inflammatory markers were unrelated to either presence or amount of CAC.     

Subsistence patterns and blood pressure variation in two rural Caboclo communities of Marajó Island,Pará, Brazil

Blood pressure (BP) increases with age in westernized societies, is higher in men, and is correlated with the body mass index (BMI). Traditional societies present more variable patterns of BP. In 1991, BP and anthropometric data from two “Caboclo” (rural populations of mixed ancestry) groups from Marajó Island, Brazil, were collected: The Paricatuba group, (N = 20;12 women), with a subsistence base of fishing, collection of palm fruits, and traditional gardening; and the Praia Grande group (N = 26; 14 women), where subsistence is based on mechanized agriculture. In Paricatuba, mean BP is 109/74 mmHg in men and 101/70 mmHg in women. There are no significant differences between BP of men and women, and systolic blood pressure (SBP) increases with age. Both SBP and diastolic blood pressure (DBP) are associated with weight, but only DBP is associated with the BMI, while SBP is associated with stature. In Praia Grande, mean BP is 120/76 mmHg in men and 118/70 mmHg in women, with no significant differences between the sexes. In Praia Grande, SBP is higher than in Paricatuba, and both SBP and DBP are associated with age. Compared with urban groups, both Caboclo samples have low BP. Still, differences in BP and body habitus between the two groups support a hypothesis that degree of westernization influences mean levels of BP in rural Amazonian populations. Further, the results also may be interpreted as suggesting that associations of sex, age, and BMI with BP, commonly reported in urban samples, are a byproduct of westernization rather than a result of genetic factors. © 1995 Wiley-Liss, Inc.     

Sex‐related differences in premature cardiovascular disease in familial hypercholesterolemia

BackgroundFamilial hypercholesterolemia (FH) is associated with an increased prevalence of premature atherosclerotic cardiovascular disease (ASCVD), however, little is known about sex-specific differences in premature ASCVD and its risk factors.ObjectiveThe present study seeks to assess the burden and risk factors for premature ASCVD among men and women with FH.MethodsIn this study we retrospectively examined sex-specific differences in ASCVD prevalence, risk factor burdens, and lipid treatment outcomes in 782 individuals with clinically or genetically confirmed FH treated in 5 U.S. lipid and genetics clinics. A generalized linear model using Binomial distribution with random study site effect and sex-stratified analysis was used to determine the strongest predictors of premature ASCVD, and lipid treatment outcomes. Covariates included age, sex, diabetes mellitus (DM), hypertension, and current smoking.ResultsAmong the cohort, 98/280 men (35%) and 89/502 women (18%) had premature ASCVD (defined as <55 years in men and <65 years in women). Women with premature ASCVD had higher mean treated total cholesterol (216 vs. 179 mg/dl, p=<0.001) and LDL-C (135 vs. 109 mg/dl, p= 0.005).ConclusionThese data confirm that high percentages of women and men with FH develop premature ASCVD, and suggest that FH may narrow the observed sex difference in premature ASCVD onset. These data support more aggressive prevention and treatment strategies in FH, including in women, to reduce non-lipid risk factors and residual hypercholesterolemia.     

Serum lipids and lipoproteins in relation to endogenous and exogenous female sex steroids and age. The Women's Health in the Lund Area (WHILA) study

BACKGROUND: Different studies have presented conflicting results concerning the effect of menopause on lipid levels. AIMS: To describe the serum lipid profile and the prevalence of hyperlipidemia in women aged 50-60 and the perceived relation to endogenous and exogenous hormones and age. METHODS: Out of a total population of 10,766 women aged 50-59 years, 6908 (64%) participated in a health assessment program, including a lipid profile evaluation. The women were grouped according to hormonal status into pre-menopausal (PM), post-menopausal without hormone replacement therapy (PM0) (HRT) and post-menopausal with hormone replacement therapy (PMT). Age groups used were 50-54, 55-59 and >60 years. RESULTS: Serum cholesterol and triglycerides increased significantly by age in PM0 (P < 0.0001) and triglycerides also in PMT (P < 0.0001). Serum high-density lipoprotein cholesterol (HDL) levels decreased significantly by age in PMT (P = 0.002) and low-density lipoprotein cholesterol (LDL) increased in PM0 (P < 0.0001) and PMT (P = 0.007). The co-prevalence of levels of cholesterol >7 and triglycerides >2 mmol/l decreased by age in PM, but increased by age in PM0 and PMT. The prevalence of high-risk lipid levels and the prevalence of coexisting additional two metabolic risk factors were higher in the PM0 compared to the PMT group. The prevalence of serum triglycerides >1.5 and serum cholesterol >5 mmol/l were increasing by age in each of the hormonal groups. CONCLUSIONS: These data suggest that loss of endogenous sex steroids contribute substantially to an increased atherogenic lipid profile. Hormone replacement therapy may partly reverse these differences.     

High cardiorespiratory fitness is more beneficial in pre-diabetic men than women

OBJECTIVES:

To investigate gender-specific relationships between cardiorespiratory fitness and factors that predict the development of diabetes and to identify the risk factors that predict fasting plasma glucose and 2-hour plasma glucose levels.

INTRODUCTION:

Different risk factors (e.g., low cardiorespiratory fitness) may cause elevated plasma glucose levels in men compared to women. Therefore, gender-specific analyses are needed.

METHODS:

Cardiorespiratory fitness (maximal power output achieved during a standard cycle ergometry test), resting blood pressure, total serum cholesterol, high-density lipoprotein cholesterol and triglyceride levels were measured in 32 pre-diabetic men (mean age: 57.2±6.8 years; mean body mass index (BMI): 28.5±3.0 kg/m²) and 40 pre-diabetic women (mean age: 55.0±7.3 years, mean BMI: 30.4±5.7 kg/m²). A stepwise regression with backward variable selection was performed to construct models that predict 2-hour and fasting plasma glucose levels.

RESULTS:

Maximal power output was inversely related to the 2-hour plasma glucose level in the entire group (r = −0.237, p<0.05), but this relationship was significant only for males (r = −0.404, p<0.05). No significant correlation was found between female gender and cardiorespiratory fitness. Age and cardiorespiratory fitness were significant predictors of 2-hour plasma glucose levels in men. High-density lipoprotein cholesterol was predictive of 2-hour plasma glucose levels in women. Triglycerides in women and BMI in men were the only predictors of fasting plasma glucose levels.

CONCLUSIONS:

These findings may have consequences for the development of gender-specific diabetes prevention programs. Whereas increasing cardiorespiratory fitness should be a key goal for men, improving the lipid profile seems to be more beneficial for women. However, the present results do not negate the positive effects of increasing cardiorespiratory fitness in women.     

Serum Lipids,Neuroendocrine, and Cardiovascular Responses to Stress in Men and Women with Mild Hypertension

Abstract

In this study, we examined the relation between serum lipid levels, gender, and cardiovascular and neuroendocrine stress reactivity in patients with mild hypertension. Ninety-nine individuals (62 men, 37 women) with mild hypertension performed four mental stress tasks: mental arithmetic, public speaking, cold stress, and a computer videogame. Cardiovascular reactivity scores were computed by subtracting the minimum resting blood pressure (BP) and heart rate (HR) values from the maximum values obtained during each task. Neuroendocrine reactivity was calculated as the change from epinephrine and norepinephrine values from mean rest to mean task. High and low reactors were identified on the basis of median splits of reactivity scores, averaged across all four stressors. High systolic blood pressure reactors had higher levels of total (TC), low-density lipoprotein cholesterol (LDL-C), and apo-B than did low reactors. High diastolic blood pressure reactors had lower levels of high-density lipoprotein cholesterol (HDL-C) and higher levels of LDL-C and apo-B than did low reactors. High HR reactors had higher apo-AI:apo-AII ratios than low reactors. Lipid levels were not different for high and low epinephrine and norepinephrine reactors. Although women were noted to have more favorable lipid profiles than men, both male and female hypertensive patients who were high reactors had less favorable lipid profiles than low reactors.     

Herpes simplex virus type 2 among mobile pastoralists in northwestern Namibia

Background: Although herpes simplex virus type 2 (HSV-2) epidemiology has been described for many western and/or urban populations, disease burden has not been characterized for remote, non-western, under treated populations, where patterns of risk and vulnerability may be very different.

Aims: To understand demographic, behavioural and geographic influences on risk for HSV-2 in a population of mobile, rural pastoralists in northwestern Namibia.

Subjects and methods: The authors conducted a cross-sectional survey of reproductively aged adults (n?=?445) across 28 villages in Kaokoveld, Namibia. All participants completed a questionnaire of demographic data, ecological interactions and sexual behaviour, and a rapid test specific for HSV-2.

Results: HSV-2 status was significantly associated with being female (OR?=?3.1, 95% CI?=?2.00, 4.71), increasing age (men: OR?=?7.5, 95% CI?=?2.67, 20.85; women: OR?=?6.2, 95% CI?=?2.48, 15.50) and with higher wealth among men (OR?=?5.1, 95% CI?=?1.98, 13.09).

Conclusions: Higher risk among women can be explained, in part, by local hygiene practices and a preference for “dry” sex. There was considerable variation in prevalence by region, which appears to be linked to geographic remoteness. Culturally contextualized epidemiologic studies of remote, vulnerable populations can provide essential information for limiting the introduction and spread of new infections.     

Social mobility by marriage and risk of cardiovascular disease among adults in Southwestern Poland

Background: The social position of a husband or wife can influence the health status of the individual and his/her partner. Also, social position can change over time as a result of education, job, income, marriage and/or divorce.

Aim: To examine the association of mobility by marriage based on educational discrepancy between spouses and risk of cardiovascular disease (CVD) among Polish men and women of 40–50 years of age.

Subjects and methods: The sample included 394 married men and 453 married women of 40–50 years of age. All were residents of Wroc?aw located in southwestern Poland. Risk of CVD was assessed with the Framingham Risk Score (FRS). The sex-specific effect of social mobility on CVD risk (FRS) was tested by multiple regression analyses.

Results: Among Polish married men and women, social mobility by marriage had a significant association with risk of CVD. Downwardly mobile men and women had a higher risk of CVD, while upwardly mobile men and women had a lower risk of CVD compared with individuals from homogamous marriages. The sole exception to this trend was poorly educated men among whom marriage with a better educated wife did not affect CVD risk.

Conclusion: Social mobility by marriage influences CVD risk. The results provide additional insights for studies examining socioeconomic differentials in CVD risk.     

Sexual minorities are at elevated risk of cardiovascular disease from a younger age than heterosexuals

Cardiovascular disease is the leading cause of death worldwide. In this study, we assessed factors related to cardiovascular disease risk and outcomes among sexual minorities (SM). Data from multiple waves of the PATH study were used in this analysis. Multivariable regression models were used to assess the association between sexual identity and: tobacco or e-cigarette use, adverse cardiovascular events, and age at first diagnosis of adverse cardiovascular disease events. In our sample (N?=?23,205), 1,660 (7.15%) participants identified as SM. SM men, relative to heterosexual men, are more likely to be diagnosed with high blood pressure (aRR?=?1.27; 95% CI 1.10, 1.47), high cholesterol (aRR?=?1.32; 95% CI: 1.12, 1.55), congestive heart failure (aRR?=?2.29; 95% CI 1.13, 4.65), stroke (aRR?=?2.39; 95% CI: 1.14, 5.04), heart attack (aRR?=?2.40; 95% CI 1.42, 4.04), and other heart conditions (aRR?=?1.52; 95% CI: 1.06, 2.18). Although no simple differences were observed among SM women compared to heterosexual women, SM women were more likely to be diagnosed at a younger age for high blood pressure (aRR?=?-0.69; 95% CI???1.08,???0.29), high cholesterol (aRR?=?-0.77; 95% CI???1.15,???0.38), stroke (aRR?=????1.04; 95% CI???1.94,???0.13), and heart attack (aRR?=????1.26; 95% CI???2.42,???0.10). SM men were only diagnosed at a younger age for stroke (aRR?=????1.18; 95% CI???2.06,???0.30). Compared to heterosexuals, sexual minorities are at higher risk for cardiovascular disease, more likely to develop cardiovascular disease at an earlier age, and more likely to use tobacco products. Future research should focus on decreasing cardiovascular risk among sexual minorities including reducing tobacco use and stress. Screening recommendations for sexual minority populations should also be reviewed in light of a growing body of literature suggesting elevated risk from a young age.

     

Lipid Profile During Pregnancy in HIV-Infected Women

Abstract

Purpose: We investigated the evolution of serum lipid levels in HIV-infected pregnant women and the potential effect of antiretroviral treatment during pregnancy using data from a national surveillance study. Method: Fasting lipid measurements collected during routine care in pregnancy were used, analyzing longitudinal changes and differences in lipid values at each trimester by protease inhibitors (PIs) and stavudine use. Multivariate analyses were used to control for simultaneous factors potentially leading to hyperlipidemia. Study population included 248 women. Results: Lipid values increased progressively and significantly during pregnancy: mean increases between the first and third trimesters were 141.6 mg/dL for triglycerides (p .001), 60.8 mg/dL for total cholesterol (p .001), 13.7 mg/dL for HDL cholesterol (p .001), and 17.8 mg/dL for LDL cholesterol (p = .001). At all trimesters, women on PIs had significantly higher triglyceride values compared to women not on PIs. The effect of PIs on cholesterol levels was less consistent. Stavudine showed a dyslipidemic effect at first trimester only. Multivariate analyses confirmed these observations and suggested a potential role of other cofactors in the development of hyperlipidemia during pregnancy. Conclusion: The changes observed point to the need to further explore the causes and the clinical correlates of hyperlipidemia during pregnancy in women with HIV.