1074 • CID 2007:45 (15 October) • HIV/AIDS
H I V / A I D SM A J O R A R T I C L E
Ten-Year Predicted Coronary Heart Disease Risk
in HIV-Infected Men and Women
Robert C. Kaplan,1Lawrence A. Kingsley,7,8A. Richey Sharrett,3Xiuhong Li,3Jason Lazar,2Phyllis C. Tien,4,5
Wendy J. Mack,6Mardge H. Cohen,9,10,11Lisa Jacobson,3and Stephen J. Gange3
1Department of Epidemiology, Albert Einstein College of Medicine, Bronx, and
Medical Center, Brooklyn, New York;
4Department of Medicine, University of California, San Francisco, and
6Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; Departments of
7Infectious Diseases and Microbiology and
2Department of Medicine, State University of New York Downstate
3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
5San Francisco Veterans Affairs Medical Center, San Francisco, and
8Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania;
10Department of Medicine, Stroger Hospital, and
9CORE Center and
11Department of Medicine, Rush Medical College, Chicago, Illinois
(See the editorial commentary by Friis-Møller and Worm on pages 1082–4).
Highly active antiretroviral therapy (HAART), in addition to traditional vascular risk factors,
may affect coronary heart disease (CHD) risk in individuals with human immunodeficiency virus (HIV) infection.
Among HIV-infected (931 men and 1455 women) and HIV-uninfected (1099 men and 576 women)
adults, the predicted risk of CHD was estimated on the basis of age, sex, lipid and blood pressure levels, the
presence of diabetes, and smoking status.
Among HIV-infected men, 2% had moderate predicted risk of CHD (10-year CHD risk, 15%–25%),
and 17% had high predicted risk (10-year CHD risk of ?25% or diabetes). Among HIV-infected women, 2% had
moderate predicted CHD risk, and 12% had high predicted CHD risk. Compared with users of protease inhibitor–
based HAART, the adjusted odds ratio (OR) for moderate-to-high risk of CHD was significantly lower among
HAART-naive individuals (OR, 0.57; 95% confidence interval [CI], 0.36–0.89). Users of HAART that was not
protease inhibitor based (OR, 0.74; 95% CI, 0.53–1.01) and former HAART users (OR, 0.68; 95% CI, 0.46–1.03)
were also less likely than users of protease inhibitor–based HAART to have moderate-to-high CHD risk, although
95% CIs overlapped the null. Low income was associated with increased likelihood of moderate-to-high CHD risk
(for annual income !$10,000 vs. 1$40,000: OR, 2.32; 95% CI, 1.51–3.56 ). Elevated body mass index (calculated
as weight in kilograms divided by the square of height in meters) predicted increased likelihood of moderate-to-
high CHD risk (for BMI of 18.5–24.9 vs. BMI of 25–30: OR, 1.41 [95% CI, 1.03–1.93]; for BMI of 18.5–24.9 vs.
BMI ?30: OR, 1.79 [95% CI, 1.25–2.56]).
Among HIV-infected adults, in addition to antiretroviral drug exposures, being overweight and
having a low income level were associated with increased predicted CHD risk. This suggests a need to target HIV-
infected men and women with these characteristics for vascular risk factor screening.
In the United States, use of HAART has prolonged
survival dramatically among HIV-infected individuals.
Therefore, the potential effects of long-term exposure
to HIV infection and antiretroviral medications on car-
diovascular disease (CVD) risk is of increasingconcern.
Received 9 March 2007; accepted 11 June 2007; electronically published 12
Reprints or correspondence: Dr. Robert C. Kaplan, Albert Einstein College of
Medicine, Belfer 1306C, 1300 Morris Park Ave., Bronx, NY 10461 (rkaplan
Clinical Infectious Diseases 2007;45:1074–81
? 2007 by the Infectious Diseases Society of America. All rights reserved.
Several studies have reported that atherosclerosis and
risk of clinical CVD events, such as myocardial infarc-
tion, may be increased with HIV infection [1–3] or use
of antiretroviral drug therapy [4–7]. However, there is
no evidence to suggest that CVD risks are reversing the
major gains in quality and duration of life associated
with HAART . Nonetheless, heart disease and stroke
are now among the leading causes of death in individ-
uals with HIV infection, as they are in the general pop-
ulation [9, 10].
factors among HIV-infected individuals use Framing-
ham equation–based risk stratification for predicting
each patient’s likelihood of sustaining a future CVD
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