Smoking and projected cardiovascular risk in an HIV‐positive Asian regional cohort

Abstract

Summary Objective To assess the prevalence of and characteristics associated with current smoking in an Asian HIV-positive cohort, calculate the predictive risks of cardiovascular disease (CVD), coronary heart disease (CHD), and myocardial infarction (MI), and identify the impact that simulated interventions may have. Methods Logistic regression analysis distinguished associated characteristics. Five-year predictive risks of CVD, CHD, MIs and the impact of simulated interventions were calculated utilizing the Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) algorithm. Results Smoking status data were collected from 4,274 participants and 1,496 of these had sufficient data for simulated intervention calculations. Current smoking prevalence in these two groups was similar (23.2% vs. 19.9%). Characteristics associated with current smoking included being ≥50 years compared to 30–39 years (OR, 0.65; 95% confidence interval [CI], 0.51–0.83), HIV exposure through injection drug use compared to heterosexual exposure (OR, 3.03; CI, 2.25–4.07), and receiving ART at study sites in Singapore, South Korea, Malaysia, Japan, and Vietnamese sites in comparison to Thailand (all odds ratios >2). Alternatively, females were less likely to smoke than males (OR, 0.11; CI, 0.08–0.14). In simulated interventions smoking cessation demonstrated the greatest impact in reducing CVD and CHD risk and closely approximated the impact of switching from abacavir to an alternate antiretroviral in the reduction of five-year MI risk. Conclusion Multiple interventions could reduce CVD, CHD, and MI risk in Asian HIV-positive patients, with smoking cessation potentially being the most influential.

Cardiovascular risk in an HIV-infected population in India

“…While a recent study of an Asian cohort classified a much greater percentage of people as high risk,22 our results are consistent with findings from South Africa 23. However, a noteworthy difference between our study population and these two studies is the younger age of our study participants.…”

Factors affecting affect cardiovascular health in Indonesian HIV patients beginning ART

“…All JakCCANDO patients received triple therapy including lamivudine, zidovudine, nevirapine, stavudine, efavirenz and/or tenofovir. None were prescribed abacavir, so the drugs administered have no confirmed association with vascular pathology [ 8 ]. Healthy controls (7 males, 4 females) aged 30 (22 to 38) years were assessed once, and data were compared with published endpoints used in clinical care.…”

“…Hence cardiovascular risk in HIV patients on ART is more effectively predicted by the D:A:D algorithm based on Framingham scores and critical anti-retroviral drugs, than by Framingham scores alone [ 7 ]. Simulated interventions applied to an Asian population found smoking cessation had the greatest potential impact on 5-year predicted risks of cardiovascular disease, approximating the effect of switching from abacavir to an alternate antiretroviral drug [ 8 ]. However abacavir is now used sparingly and the standard regimes cause minimal cardiovascular toxicity [ 9 ].…”

Risk of cardiovascular disorders in HIV patients in Indonesia: Literature Review

“…Smoking plays a role in the risk of the incidence of coronary heart disease in HIVpositive population (21). A cohort study aimed at predicting the risk of coronary heart disease in smoking HIV patients in Asia, including in Indonesia concluded that HIV patients who smoke in Indonesia are three times at risk of coronary heart disease than non-smoking HIV patients, and patients who do not smoke can reduce five years risk of coronary heart disease (22). The results of the study were similar to a cohort study of 33,308 HIV patients who concluded that there was a reduced risk of myocardial infarction and heart disease after a year the patient stopped smoking, and after three years reduced the risk of half heart disease from the first year (12).…”