Cardiovascular risk evaluation and antiretroviral therapy effects in an HIV cohort: implications for clinical management: the CREATE 1 study

Abstract

Aims:The aim of this study is to determine the cardiovascular disease (CVD) risk profile of a large UK HIV cohort and how highly active antiretroviral therapy (HAART) affects this.Methods:It is a cross-sectional study within a large inner city hospital and neighbouring district hospital. A total of 1021 HIV positive outpatients representative of the complete cohort and 990 who had no previous CVD were included in CVD risk analysis. We recorded demographics, HAART history and CVD risk factors. CVD and coronary heart disease (CHD) risks were calculated using the Framingham (1991) algorithm adjusted for family history.Results:The non-CVD cohort (n = 990) was 74% men, 51% Caucasian and 73.1% were on HAART. Mean age was 41 ± 9 years, systolic blood pressure 120 ± 14 mmHg, total cholesterol 4.70 ± 1.05mmol/l, high-density lipoprotein-C 1.32 ± 0.48 mmol/l and 37% smoked. Median CVD risk was 4 (0–56) % in men and 1.4 (0–37) % in women; CHD risks were 3.5 (0–36) % and 0.6 (0–16) %. CVD risk was > 20% in 6% of men and 1% of women and > 10% in 12% of men and 4% of women. CVD risk was higher in Caucasians than other ethnicities; the risk factor contributing most was raised cholesterol. For patients on their first HAART, increased CHD risk (26.2% vs. 6.5%; odds ratio 4.03, p < 0.001) was strongly related to the duration of therapy.Conclusions:Modifiable risk factors, especially cholesterol, and also duration of HAART, were key determinants of CVD risk.Discussion:Regular CHD and/or CVD risk assessment should be performed on patients with HIV, especially during HAART therapy. The effect of different HAART regimens on CHD risk should be considered when selecting therapy.

Impact of antiretroviral therapy on serum lipoprotein levels and dyslipidemias: A systematic review and meta-analysis

“…There were 37,110 HIV-infected patients in total, with females representing approximately 28%. Thirty-one studies (61%) were conducted in low-and middleincome countries with the highest number of studies (n = 8) reported in India [22,27,29,30,45,47,59,61], followed by six studies in Nigeria [24,31,34,36,50,54], and four studies each in Brazil [23,32,41,44], Norway [15,16,55,62], and USA [17,39,40,53]. Nonetheless, studies conducted in high-income countries were generally larger in size (n = 30,120 participants), compared with studies conducted in low-and middleincome countries (n = 7488).…”

HIV and cardiovascular disease: comment on Islam et al.

“…The study by Aboud et al [6] was not a study of cardiovascular disease (CVD) or coronary heart disease (CHD) events. It was a study of predicted CVD or CHD using a Framingham risk formula.…”

“…This study should not have been included in the meta-analysis. A second problem, but minor by comparison, is that the two estimates cited from Aboud et al [6] are correlated and cannot simply be pooled.…”

Somatótipo E Imagem Corporal Em Pessoas Vivendo Com Hiv/Aids

“…Levando em consideração o risco cardiovascular inerente ás PVHA sob HAART 14 , essa tendência ao aumento do componente ectomórfico parece ser benéfica, uma vez que a literatura 17 constatou a ectomorfia como o único componente a exibir relação inversa com a pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD), ou seja, à medida que a ectomorfia aumenta, a PAD e PAS diminui, sugerindo que uma maior linearidade pode melhorar o perfil de risco cardiovascular. Essa ideia é reforçada pela relação inversa entre a ectomorfia e índices gerais de adiposidade 18 , sendo este fator considerado como um dos maiores preditores de DCNT.…”