Article

Ischemic Heart Disease in HIV-Infected and HIV-Uninfected Individuals: A Population-Based Cohort Study

Department of Infectious Diseases, Rigshospitalet, Hvidovre, Denmark.
Clinical Infectious Diseases (Impact Factor: 9.42). 07/2007; 44(12):1625-31. DOI: 10.1086/518285
Source: PubMed

ABSTRACT There are concerns about highly active antiretroviral therapy (HAART) causing a progressive increase in the risk of ischemic heart disease. We examined this issue in a nationwide cohort study of patients with human immunodeficiency virus (HIV) infection and a population-based control group.
We determined the rate of first hospitalization for ischemic heart disease in all Danish patients with HIV infection (3953 patients) from 1 January 1995 through 31 December 2004 and compared this rate with that for 373,856 subjects in a population-based control group. Data on first hospitalization for ischemic heart disease and comorbidity were obtained from the Danish National Hospital Registry for all study participants. We used Cox's regression to compute the hospitalization rate ratio as an estimate of relative risk, adjusting for comorbidity.
Although the difference was not statistically significant, patients with HIV infection who had not initiated HAART were slightly more likely to be hospitalized for the first time with ischemic heart disease than were control subjects (adjusted relative risk, 1.39; 95% confidence interval, 0.81-2.33). After HAART initiation, the risk increase became substantially higher (adjusted relative risk, 2.12; 95% confidence interval, 1.62-2.76), but the relative risk did not further increase in the initial 8 years of HAART.
Compared with the general population, HIV-infected patients receiving HAART have an increased risk of ischemic heart disease, but the relative risk is stable up to 8 years after treatment initiation.

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    • "To the best of our knowledge, the present study is the widest and the most detailed study focusing on this issue. Even if cardiovascular diseases were the second cause of CA in our cohort, they have been largely assessed in the overall HIV-infected population [21], because the risk of heart disease is consistently at least 1.5 to 2.0 times higher than among matched HIV-uninfected adults [22] [23] [24] [25]. "
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    • "Some have used positron emission tomography scanning to identify increased vascular inflammation as another potential non-invasive measurement of endothelial function (Kim et al., 2010). Chronic inflammation is a well-known risk factor for cardiovascular disease (Obel et al., 2007; Triant et al., 2007). Many groups investigated the potential impact of anti-inflammatory drugs (e.g., NSAIDs) on endothelial function. "
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    Frontiers in Physiology 08/2014; 5:328. DOI:10.3389/fphys.2014.00328 · 3.50 Impact Factor
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    • "at least a similar impact on cardiovascular disease (CVD) in this population as they do in the general population [15] [16] [17]. However, both HIV replication and antiretroviral therapy may contribute independently to an increased risk of CVD [4, 8–14, 18–20]. "
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    ABSTRACT: Background. There are conflicting data on the prevalence of coronary events and the quality of the management of modifiable cardiovascular risk factors (CVRF) in HIV-infected patients. Methods. We performed a retrospective descriptive study to determine the prevalence of coronary events and to evaluate the management of CVRF in a Mediterranean cohort of 3760 HIV-1-infected patients from April 1983 through June 2011. Results. We identified 81 patients with a history of a coronary event (prevalence 2.15%); 83% of them suffered an acute myocardial infarction. At the time of the coronary event, CVRF were highly prevalent (60.5% hypertension, 48% dyslipidemia, and 16% diabetes mellitus). Other CVRF, such as smoking, hypertension, lack of exercise, and body mass index, were not routinely assessed. After the coronary event, a significant decrease in total cholesterol (P = 0.025) and LDL-cholesterol (P = 0.004) was observed. However, the percentage of patients who maintained LDL-cholesterol > 100 mg/dL remained stable (from 46% to 41%, P = 0.103). Patients using protease inhibitors associated with a favorable lipid profile increased over time (P = 0.028). Conclusions. The prevalence of coronary events in our cohort is low. CVRF prevalence is high and their management is far from optimal. More aggressive interventions should be implemented to diminish cardiovascular risk in HIV-infected patients.
    BioMed Research International 08/2014; 2014:823058. DOI:10.1155/2014/823058 · 2.71 Impact Factor
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