Prevalence of risk factors for cardiovascular disease in HIV‐infected patients over time: the Swiss HIV Cohort Study

Abstract

Objective Metabolic changes caused by antiretroviral therapy (ART) may increase the risk of coronary heart disease (CHD). We evaluated changes in the prevalence of cardiovascular risk factors (CVRFs) and 10‐year risk of CHD in a large cohort of HIV‐infected individuals. Methods All individuals from the Swiss HIV Cohort Study (SHCS) who completed at least one CVRF questionnaire and for whom laboratory data were available for the period February 2000 to February 2006 were included in the analysis. The presence of a risk factor was determined using cut‐offs based on the guidelines of the National Cholesterol Education Program (NCEP ATP III), the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), the American Diabetes Association, and the Swiss Society for Cardiology. Results Overall, 8033 individuals completed at least one CVRF questionnaire. The most common CVRFs in the first completed questionnaire were smoking (57.0%), low high‐density lipoprotein (HDL) cholesterol (37.2%), high triglycerides (35.7%), and high blood pressure (26.1%). In total, 2.7 and 13.8% of patients were categorized as being at high (>20%) and moderate (10–20%) 10‐year risk for CHD, respectively. Over 6 years the percentage of smokers decreased from 61.4 to 47.6% and the percentage of individuals with total cholesterol >6.2 mmol/L decreased from 21.1 to 12.3%. The prevalence of CVRFs and CHD risk was higher in patients currently on ART than in either pretreated or ART‐naive patients. Conclusion During the 6‐year observation period, the prevalence of CVRFs remains high in the SHCS. Time trends indicate a decrease in the percentage of smokers and individuals with high cholesterol.

Comorbidity-Related Treatment Outcomes among HIV-Infected Adults in the Bronx, NY

“…Such conditions affected 13-48% of our subjects, rates similar to those published from other studies of HIV-infected patients. 3,14,15 Our work also demonstrates that many relationships between traditional risk factors and chronic diseases in the general population (e.g., obesity and hypertension) persist for HIV-infected patients. Furthermore, although much has been made of the contribution of antiretroviral therapy toward development of these conditions, our study indicates that the risk conferred by traditional factors is often comparable toand occasionally greater than-that due to antiretroviral therapy.…”

“…Increased rates of dyslipidemia, cardiovascular disease, and diabetes are welldocumented, [1][2][3] with multiple factors (inflammation caused by HIV, antiretroviral effects, traditional risk factors, etc.) accounting for these findings.…”

Association of non-HDL cholesterol with subclinical atherosclerosis in HIV-positive patients

“…LDL-C was calculated with the Friedwald's formula for TG < 4.5 mmol/l; non-HDL-C was 5 defined as (TC -HDL-C). ApoA1 and apoB were measured by immunonephelemetric method.…”

“…However emergence of cardiovascular (CV) complications related to HIV infection per se and/or to c-ART has raised clinical and public health concerns [2][3][4][5] given the increasing duration of exposure to c-ART. Several classical CV risk factors including age, gender, body mass index (BMI), blood pressure, increased total cholesterol (TC) levels or tobacco consumption have been previously recognized in HIV+ patients 6 .…”

Trends in non-AIDS-related causes of death among adults with HIV/AIDS, Brazil, 1999 to 2010

“…Some studies have shown greater risk of cardiovascular events in persons with HIV/AIDS and on HAART as compared to those without treatment 21,22 . Among the antiretroviral drugs, the protease inhibitors 23 , lopinavir-ritonavir or indinavir 24 , and regimens containing abacavir or didanosine 25 show greater risk of cardiovascular diseases.…”