Coronary artery disease uncommon in people with HIV in Uganda

People with HIV in Uganda do not have a higher prevalence of coronary artery disease compared to people without HIV. Among both groups, the prevalence of coronary artery disease was low compared to populations in Europe and North America, a study presented last week at the Conference on Retroviruses and Opportunistic Infections (CROI 2025) in San Francisco shows.

The findings suggest that giving statins as a measure to prevent heart disease in people with HIV at low-to-moderate risk of heart disease may not be priority in African populations.

Studies in high-income countries have shown consistently that people with HIV are at higher risk of cardiovascular disease than the rest of the population. But few studies have looked at cardiovascular disease in people with HIV in Africa, where the majority of people with HIV live.

A large international study, REPRIEVE, reported in 2023 that daily use of pitavastatin by people with HIV reduced the risk of a major cardiovascular event such as stroke or heart attack by 36% in people judged to have a low-to-moderate risk of heart disease. However, the study found that the risk reduction varied by region of the world, and that the effect of statin treatment was not statistically significant in participants outside high-income countries and south Asia. This is probably explained by the lower number of cardiovascular events recorded in those regions.

Dr Mark Siedner of Harvard University presented results from the Uganda Coronary Artery Disease Study, which was designed to investigate the prevalence of coronary artery disease in people over the age of 40 in Uganda.

The study recruited 287 adults with HIV, on antiretroviral treatment for at least three years, and 299 age- and sex-matched HIV-negative controls to undergo screening for coronary artery disease. All participants received a CT scan to measure calcium levels and a coronary CT angiography to measure plaque, both in the coronary arteries.

Study participants had a mean age of 57 years, 49% were female and 95% of people with HIV had suppressed viral load. Just under two-thirds (63%) of people with HIV were agricultural workers.

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

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

The prevalence of coronary artery disease found in this rural population in Uganda is much lower than prevalence observed in other regions. Recent large general population studies have found prevalence of around 50% in the United States, 40% in Sweden and 20% in South Korea.

The Uganda Coronary Artery Disease Study research group is working to compare cardiovascular risks between rural and urban populations in Uganda. Dr Siedner noted, “The amount of activity reported by this group is about ten times more than what the average American reports. They work hard each day to provide subsistence for their families, and I can’t help but think that their lifestyle, as subsistence farmers, does contribute to increased health in terms of coronary artery disease.”

Dr Roger Bedimo of University of Texas Southwestern Medical Service asked how clinicians in Africa should use risk models for cardiovascular disease, given that models over-predicted risk in sub-Saharan Africa in the REPRIEVE study.

“Our findings highlight the importance of local data,” answered Dr Siedner. “We have a lot of data to collect to build models that are predictive.”

“We absolutely need to develop region-specific scores for sub-Saharan Africa,” said Professor Steven Grinspoon, principal investigator on the REPRIEVE study.