Asymptomatic myocardial ischaemia in HIV-infected adults

Carr, Andrew; Grund, Birgit; Neuhaus, Jacqueline; El‐Sadr, Wafaa; Grandits, Gregory A; Gibert, Cynthia L.; Prineas, Ronald J.

doi:10.1097/qad.0b013e3282f20a77

Cited by 33 publications

(25 citation statements)

References 24 publications

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“…A recent cohort study found that 40% of HIV-infected individuals were smokers [30], compared with 27% of the Danish population as a whole in 2006 [31]. This difference is small and could not have accounted for our findings.…”

Section: Discussionmentioning

confidence: 61%

Hospitalization for Pneumonia among Individuals With and Without HIV Infection, 1995–2007: A Danish Population‐Based, Nationwide Cohort Study

et al. 2008

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Section: Discussionmentioning

confidence: 61%

Hospitalization for Pneumonia among Individuals With and Without HIV Infection, 1995–2007: A Danish Population‐Based, Nationwide Cohort Study

et al. 2008

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“…In the Strategies for Management of Antiretroviral Therapy Study, interruption of antiretroviral treatment was associated with an increased short-term risk of cardiovascular disease, 27 and a high proportion of asymptomatic myocardial ischemia was found in HIVinfected adults, irrespective of their antiretroviral treatment status. 28 In another study, HIV patients who had not initiated antiretroviral treatment had a higher risk of hospitalization for ischemic heart disease than a population-based control group. 29 Pathogenetic research supports the direct role of HIV in accelerating arteriosclerosis.…”

Section: Discussionmentioning

confidence: 99%

“…These findings suggest HIV infection as a potentially relevant contributor to arteriosclerosis and provide a conceptual background for the increased cardiovascular risk observed among HIV-infected individuals regardless of antiretroviral treatment. 28,29 Close, noninvasive evaluation of preclinical atherosclerotic disease should be considered for HIV patients, especially those with additional risk factors for cardiovascular diseases, with the aim of addressing intensive lifestyle and pharmacological interventions aimed at reducing cardiovascular risk.…”

Section: Clinical Perspectivesmentioning

confidence: 99%

Aortic Stiffness in Untreated Adult Patients With Human Immunodeficiency Virus Infection

et al. 2008

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Abstract-HIV infection is associated with chronic immune activation, subclinical inflammation, and an atherogenic metabolic profile. It remains controversial whether HIV infection is a risk factor for accelerated arteriosclerosis independent from the effects of antiretroviral drugs. We investigated whether aortic stiffness, an early marker of arteriosclerosis, is increased in HIV patients who were not under antiretroviral treatment. In 39 untreated HIV-infected patients and 78 individually matched age-, sex-, and blood pressure-matched HIV-uninfected control subjects, we determined aortic pulse wave velocity (PWV), a direct noninvasive measure of aortic stiffness, by tonometric method. Subjects with overt cardiovascular disease or major cardiovascular risk factors were excluded from the study. Prevalence of the metabolic syndrome was higher in HIV patients (18% versus 5%; Pϭ0.025). HIV patients had a higher aortic PWV (7.5Ϯ1.4 versus 6.7Ϯ1.1 m ⅐ s Ϫ1 ; Pϭ0.001) than control subjects. Age, mean arterial pressure as a measure of distending pressure, and HIV infection (all PϽ0.05) independently predicted aortic PWV when a consistent number of cardiovascular risk factors was simultaneously controlled for. Among HIV-infected subjects, serum ␥-glutamyl transpeptidase concentration (␤ϭ0.46; Pϭ0.003) and mean arterial pressure (␤ϭ0.32; Pϭ0.03) were independent determinants of aortic PWV. In conclusion, aortic stiffness is increased in HIV-infected individuals who have never received antiretroviral therapy. PWV increases with increasing serum ␥-glutamyl transpeptidase concentration. Our data support the hypothesis that HIV infection is a risk factor for arteriosclerosis. (Hypertension. 2008;52:308-313.)

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“…By comparison, the risk increased 32% for each additional year of age, and was 280% greater for current tobacco smokers (compared with nonsmokers) and 74% greater for persons with a BMI greater than 30 compared with a BMI of 18 to 26 [35•]. Carr et al [38], for the SMART study, also confi rmed that traditional factors were the predominant determinants of risk for asymptomatic myocardial ischemia events in that study.…”

Section: Cardiovascular Disease and Metabolic Abnormalitiesmentioning

confidence: 89%

Changes in the clinical epidemiology of HIV infection in the United States: Implications for the clinician

Rangel¹,

Blacher²,

Brooks³

2008

Curr Infect Dis Rep

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The HIV epidemic in the United States continues to affect racial/ethnic minorities disproportionately and is increasing among men who have sex with men. Late HIV diagnosis remains common. To reduce HIV transmission and facilitate early linkage to care and antiretroviral treatment, the Centers for Disease Control and Prevention recommends universal voluntary HIV screening for all persons ages 13 to 64 years in public and private care settings. Recent studies demonstrate dramatic reductions in morbidity and mortality with widespread use of highly active combination antiretroviral therapy (cART), and some document improved outcomes when cART is initiated with CD4 cell count >/= 350 cells/mm(3). As patients live longer, they are increasingly affected by chronic diseases, notably cardiovascular and renal disease, diabetes, and non-AIDS-defining cancers. Providers should ensure patients undertake preventive lifestyle changes (eg, smoking cessation, exercise, weight loss, dietary modification) and undergo recommended screening tests to reduce their risk for these important comorbidities.

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Asymptomatic myocardial ischaemia in HIV-infected adults

Abstract: ECG evidence of asymptomatic IHD was common in this large cohort of HIV-infected adults and more common than a history of symptomatic IHD. Traditional factors were the predominant determinants of risk. No clear association between ART type or duration and asymptomatic IHD was noted.

Cited by 33 publications

References 24 publications

Hospitalization for Pneumonia among Individuals With and Without HIV Infection, 1995–2007: A Danish Population‐Based, Nationwide Cohort Study

Hospitalization for Pneumonia among Individuals With and Without HIV Infection, 1995–2007: A Danish Population‐Based, Nationwide Cohort Study

Aortic Stiffness in Untreated Adult Patients With Human Immunodeficiency Virus Infection

Changes in the clinical epidemiology of HIV infection in the United States: Implications for the clinician

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