Abstract
INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of premature mortality in Kazakhstan and across Eastern Europe and Central Asia. As life expectancy increases among people living with HIV (PLWH) receiving antiretroviral therapy (ART), cardiovascular risk has become a major clinical concern. However, data on CVD risk distribution and cardiac biomarkers among older PLWH in Kazakhstan remain limited. This study aimed to estimate the prevalence of CVD risk factors, assess 10-year CVD risk using SCORE2/SCORE2-OP, and evaluate the role of NT-proBNP among PLWH aged ≥ 40 years in Almaty. METHODS: A cross-sectional study was conducted among 150 PLWH aged ≥ 40 years attending the Almaty City AIDS Center between February and July 2023. Sociodemographic, behavioral, clinical, and laboratory data were collected. Ten-year CVD risk was calculated using SCORE2 (ages 40-69 years) and SCORE2-OP (≥ 70 years). Multivariable logistic regression was used to identify predictors of elevated NT-proBNP (≥ 125 pg/mL). RESULTS: The mean age was 51.6 ± 10.4 years, and 54.7% of participants were male. ART coverage was 95%, with 76.7% achieving viral suppression. Smoking (76.1%) and alcohol use (65.5%) were highly prevalent. Overall, 29.3% of participants had low, 40.7% moderate, and 30.0% high 10-year CVD risk; 54% were classified as moderate or high risk. Elevated NT-proBNP (≥ 125 pg/mL) was observed in 36.3% of participants. In multivariable analysis, older age was independently associated with elevated NT-proBNP (adjusted odds ratio [aOR] per 1-year increase: 1.10; 95% CI: 1.04-1.15; p = 0.0004), whereas HIV viral load, blood pressure, sex, and triglyceride levels were not independently associated. CONCLUSIONS: More than half of older PLWH in this urban Kazakhstan cohort had moderate or high predicted 10-year CVD risk despite high ART coverage. Traditional cardiovascular risk factors were the primary drivers. Integration of routine CVD risk assessment and targeted prevention strategies into HIV care is urgently needed.