Predictors of subclinical atherosclerosis in HIV.

BACKGROUND: Cardiovascular disease is a major cause of morbidity and mortality in people with HIV. The detection of subclinical atherosclerosis through vascular ultrasound allows us to identify patients at an increased risk of cardiovascular disease as a primary prevention strategy; this test is not routine. Our objective is to identify predictors of subclinical atherosclerosis in a population with HIV. METHODS: People with HIV infection were selected for primary prevention and underwent carotid and femoral ultrasound to detect atheromatous plaques. Logistic regression analysis including vascular risk factors was performed to predict the presence of atherosclerosis. RESULTS: One hundred eighty-three patients were included, 54% of whom were smokers; the mean duration of HIV infection was 9.52 years, and all patients were undergoing antiretroviral treatment. Subclinical atherosclerosis was present in 62.29% of the patients; 83.32% had plaque in the carotid territory, 57.93% in the femoral territory and 25.6% in both vascular territories. Compared to those without atherosclerosis, patients with atherosclerosis were on average 5.35 years older (53.86 vs. 48.51, p < 0.001) and had a higher prevalence of smoking (63.23% vs. 39.12%, p = 0.020) and a CD4/CD8 ratio below 0.7 (44.23% vs. 29.02%, p = 0.043). A CD4/CD8 ratio lower than 0.3 was always associated with subclinical atherosclerosis (95% confidence interval (CI): 83.9-100%). The inclusion of smoking, the CD4/CD8 ratio and age in the logistic regression analysis led to a diagnostic yield of 72% measured by the area under the receiving operator characteristic (ROC) curve (95% CI: 64-80%). CONCLUSIONS: Tobacco use, age and a CD4/CD8 ratio below 0.7 allow prediction of the presence of subclinical atherosclerosis in primary prevention. A CD4/CD8 ratio below 0.3 was a diagnostic indicator of atherosclerosis in HIV patients undergoing primary prevention in our sample.

Incorporación de parámetros bioquímicos y algoritmos diagnósticos en el sistema informático de laboratorio para la detección precoz de alteraciones lipídicas desde las unidades de lípidos / Incorporation of biochemical parameters and diagnostic algorithms in the laboratory computer system for the early detection of lipid abnormalities from the lipid units

Introducción: La combinación de marcadores bioquímicos y el diseño e implementación de algoritmos diagnósticos en el sistema informático de los laboratorios podrían convertirse en herramientas muy potentes en la estratificación del riesgo cardiovascular. Objetivos: Implementar nuevos marcadores bioquímicos y algoritmos diagnósticos hasta ahora no disponibles para facilitar la estimación del riesgo cardiovascular y la orientación diagnóstica de las alteraciones lipídicas. Material y métodos: Estudio para la implementación de apolipoproteína B y de lipoproteína (a), así como la inclusión de diferentes algoritmos diagnósticos. Se ha realizado conjuntamente entre las diferentes unidades de lípidos de la Sociedad Española de Arteriosclerosis, Hospital Virgen Macarena de Sevilla, Hospital Juan Ramón Jiménez, Hospital Infanta Elena y Hospital de Río Tinto durante los años 2018 y 2019. Resultados: Se han aplicado 4 algoritmos diagnósticos en el sistema de información del laboratorio, que mostraron 9.985 pacientes totales con c-LDL>200mg/dl. Según el algoritmo diagnóstico, que se amplió para que incluyera ApoB, 8.182 determinaciones presentaban una apolipoproteína B>100mg/dl. Se determinaron 747 casos de lipoproteína (a), de las cuales un 30,65% fueron superiores a 50mg/dl. El 71,80% presentaban resultados compatibles con partículas de LDL pequeñas y densas. Conclusiones: La implementación de nuevos parámetros analíticos y el uso de algoritmos en los laboratorios en atención primaria permite identificar un número considerable de pacientes con diferentes alteraciones en el metabolismo lipídico que, junto con los factores de riesgo clásicos, podría contribuir a una correcta estratificación de riesgo y a evitar la progresión de la enfermedad cardiovascular.(AU)

Introduction: The combination of biochemical markers, together with the design and implementation of diagnostic algorithms in laboratory computer systems could become very powerful tools in the stratification of cardiovascular risk. Objectives: To implement new biochemical markers and diagnostic algorithms not yet available, in order to provide an estimation of cardiovascular risk and the diagnostic orientation of lipid alterations. Material and methods: Study of the implementation of apolipoprotein B and lipoprotein (a), as well as the inclusion of different diagnostic algorithms. This was carried out jointly by the different Lipid Units of the Spanish Society of Atherosclerosis, Hospital Virgen Macarena in Seville, Hospital Juan Ramón Jiménez, Hospital Infanta Elena, and Hospital de Río Tinto during 2018 and 2019. Results: The 4diagnostic algorithms entered into the Laboratory Information System, showed a total of 9,985 patients with c-LDL>200mg/dl. The diagnostic algorithm was extended to include Apo B, with 8,182 determinations showing an apolipoprotein B>100mg/dl). A total of 747 lipoprotein (a) were determined, of which 30.65% were> 50mg/dl. More than 2/3 (71.80%) showed results compatible with small and dense LDL particles. Conclusions: The implementation of new analytical parameters and algorithms in Primary Care laboratory results can identify a considerable number of patients with different alterations in lipid metabolism. This, together with the classic risk factors, could contribute to a correct risk stratification in preventing the progression of cardiovascular disease.(AU)

Incorporation of biochemical parameters and diagnostic algorithms in the laboratory computer system for the early detection of lipid abnormalities from the lipid units. / Incorporación de parámetros bioquímicos y algoritmos diagnósticos en el sistema informático de laboratorio para la detección precoz de alteraciones lipídicas desde las unidades de lípidos.

INTRODUCTION: The combination of biochemical markers, together with the design and implementation of diagnostic algorithms in laboratory computer systems could become very powerful tools in the stratification of cardiovascular risk. OBJECTIVES: To implement new biochemical markers and diagnostic algorithms not yet available, in order to provide an estimation of cardiovascular risk and the diagnostic orientation of lipid alterations. MATERIAL AND METHODS: Study of the implementation of apolipoprotein B and lipoprotein (a), as well as the inclusion of different diagnostic algorithms. This was carried out jointly by the different Lipid Units of the Spanish Society of Atherosclerosis, Hospital Virgen Macarena in Seville, Hospital Juan Ramón Jiménez, Hospital Infanta Elena, and Hospital de Río Tinto during 2018 and 2019. RESULTS: The 4diagnostic algorithms entered into the Laboratory Information System, showed a total of 9,985 patients with c-LDL>200mg/dl. The diagnostic algorithm was extended to include Apo B, with 8,182 determinations showing an apolipoprotein B>100mg/dl). A total of 747 lipoprotein (a) were determined, of which 30.65% were> 50mg/dl. More than 2/3 (71.80%) showed results compatible with small and dense LDL particles. CONCLUSIONS: The implementation of new analytical parameters and algorithms in Primary Care laboratory results can identify a considerable number of patients with different alterations in lipid metabolism. This, together with the classic risk factors, could contribute to a correct risk stratification in preventing the progression of cardiovascular disease.