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HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction.
Paisible, Anne-Lise; Chang, Chung-Chou H; So-Armah, Kaku A; Butt, Adeel A; Leaf, David A; Budoff, Matthew; Rimland, David; Bedimo, Roger; Goetz, Matthew B; Rodriguez-Barradas, Maria C; Crane, Heidi M; Gibert, Cynthia L; Brown, Sheldon T; Tindle, Hilary A; Warner, Alberta L; Alcorn, Charles; Skanderson, Melissa; Justice, Amy C; Freiberg, Matthew S.
Afiliación
  • Paisible AL; *Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Departments of †Biostatistics; ‡Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; ‖Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA David Geffen School of Medicine at UC
J Acquir Immune Defic Syndr ; 68(2): 209-16, 2015 Feb 01.
Article en En | MEDLINE | ID: mdl-25588033
ABSTRACT

BACKGROUND:

Traditional cardiovascular disease risk factors (CVDRFs) increase the risk of acute myocardial infarction (AMI) among HIV-infected (HIV+) participants. We assessed the association between HIV and incident AMI within CVDRF strata.

METHODS:

Cohort-81,322 participants (33% HIV+) without prevalent CVD from the Veterans Aging Cohort Study Virtual Cohort (prospective study of HIV+ and matched HIV- veterans) participated in this study. Veterans were followed from first clinical encounter on/after April 1, 2003, until AMI/death/last follow-up date (December 31, 2009). Predictors-HIV, CVDRFs (total cholesterol, cholesterol-lowering agents, blood pressure, blood pressure medication, smoking, diabetes) used to create 6 mutually exclusive profiles all CVDRFs optimal, 1+ nonoptimal CVDRFs, 1+ elevated CVDRFs, and 1, 2, 3+ major CVDRFs. Outcome-Incident AMI [defined using enzyme, electrocardiogram (EKG) clinical data, 410 inpatient ICD-9 (Medicare), and/or death certificates]. Statistics-Cox models adjusted for demographics, comorbidity, and substance use.

RESULTS:

Of note, 858 AMIs (42% HIV+) occurred over 5.9 years (median). Prevalence of optimal cardiac health was <2%. Optimal CVDRF profile was associated with the lowest adjusted AMI rates. Compared with HIV- veterans, AMI rates among HIV+ veterans with similar CVDRF profiles were higher. Compared with HIV- veterans without major CVDRFs, HIV+ veterans without major CVDRFs had a 2-fold increased risk of AMI (HR 2.0; 95% confidence interval 1.0 to 3.9; P = 0.044).

CONCLUSIONS:

The prevalence of optimal cardiac health is low in this cohort. Among those without major CVDRFs, HIV+ veterans have twice the AMI risk. Compared with HIV- veterans with high CVDRF burden, AMI rates were still higher in HIV+ veterans. Preventing/reducing CVDRF burden may reduce excess AMI risk among HIV+ people.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por VIH / Infarto del Miocardio Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Acquir Immune Defic Syndr Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2015 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones por VIH / Infarto del Miocardio Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Acquir Immune Defic Syndr Asunto de la revista: SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS) Año: 2015 Tipo del documento: Article