Changes over time in risk factors for cardiovascular disease and use of lipid-lowering drugs in HIV-infected individuals and impact on myocardial infarction

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Research output: Contribution to journalArticlepeer-review

54 Scopus citations

Abstract

Background. Because of the known relationship between exposure to combination antiretroviral therapy and cardiovascular disease (CVD), it has become increasingly important to intervene against risk of CVD in human immunodeficiency virus (HIV)-infected patients. We evaluated changes in risk factors for CVD and the use of lipid-lowering therapy in HIV-infected individuals and assessed the impact of any changes on the incidence of myocardial infarction. Methods. The Data Collection on Adverse Events of Anti-HIV Drugs Study is a collaboration of 11 cohorts of HIV-infected patients that included follow-up for 33,389 HIV-infected patients from December 1999 through February 2006. Results. The proportion of patients at high risk of CVD increased from 35.3% during 1999-2000 to 41.3% during 2005-2006. Of 28,985 patients, 2801 (9.7%) initiated lipid-lowering therapy; initiation of lipid-lowering therapy was more common for those with abnormal lipid values and those with traditional risk factors for CVD (male sex, older age, higher body mass index [calculated as the weight in kilograms divided by the square of the height in meters], family and personal history of CVD, and diabetes mellitus). After controlling for these, use of lipid-lowering drugs became relatively less common over time. The incidence of myocardial infarction (0.32 cases per 100 person-years [PY]; 95% confidence interval [CI], 0.29-0.35 cases per 100 PY) appeared to remain stable. However, after controlling for changes in risk factors for CVD, the rate decreased over time (relative rate in 2003 [compared with 1999-2000], 0.73 cases per 100 PY [95% CI, 0.50-1.05 cases per 100 PY]; in 2004, 0.64 cases per 100 PY [95% CI, 0.44-0.94 cases per 100 PY]; in 2005-2006, 0.36 cases per 100 PY [95% CI, 0.24-0.56 cases per 100 PY]). Further adjustment for lipid levels attenuated the relative rates towards unity (relative rate in 2003 [compared with 1999-2000], 1.06 cases per 100 PY [95% CI, 0.63-1.77 cases per 100 PY]; in 2004, 1.02 cases per 100 PY [95% CI, 0.61-1.71 cases per 100 PY]; in 2005-2006, 0.63 cases per 100 PY [95% CI, 0.36-1.09 cases per 100 PY]). Conclusions. Although the CVD risk profile among patients in the Data Collection on Adverse Events of Anti- HIV Drugs Study has decreased since 1999, rates have remained relatively stable, possibly as a result of a more aggressive approach towards managing the risk of CVD.

Original languageEnglish (US)
Pages (from-to)1101-1110
Number of pages10
JournalClinical Infectious Diseases
Volume46
Issue number7
DOIs
StatePublished - Apr 1 2008

Bibliographical note

Funding Information:
Financial support. Health Insurance Fund Council (CURE/97–46486 to the AIDS Therapy Evaluation Project Netherlands); Agence Nationale de Recherches sur le SIDA (Action Coordonnée no.7, Cohortes to the Aquitaine Cohort); Australian Government Department of Health and Ageing, Foundation for AIDS Research, and National Institute of Allergy and Infectious Diseases (NIAID), National Insitutes of Health (NIH; UO1-AI069907 to the Australian HIV Observational Database); Fondo de In-vestigación Sanitaria (FIS 99/0887) and Fundación para la Investigación y la Prevención del SIDA en Espanã (FIPSE 3171/00) to the Barcelona An-tiretroviral Surveillance Study; NIAID, NIH (5U01AI042170–10 and 5U01AI046362–03 to the Terry Beirn Community Programs for Clinical Research on AIDS); BIOMED 1 (CT94–1637) and BIOMED 2 (CT97– 2713) programs and the fifth framework program (QLK2–2000-00773) of the European Commission; Bristol-Myers Squibb, GlaxoSmithKline, Boehringer Ingelheim, and Roche to the EuroSIDA study; Glaxo Wellcome to the Italian Cohort Naive to Antiretrovirals; and Swiss National Science Foundation to the Swiss HIV Cohort Study. The Data Collection on Adverse Events of Anti-HIV Drugs Study Group is supported by the Oversight Committee for The Evaluation of Metabolic Complications of HAART, a collaborative committee with representation from academic institutions, the European Agency for the Evaluation of Medicinal Products, the US Food and Drug Administration, the patient community, and all pharmaceutical companies with licensed anti-HIV drugs in the US market: Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Glaxo-SmithKline, Merck, Pfizer, and Hoffman-LaRoche. Potential conflicts of interest. All authors: no conflicts.

Publisher Copyright:
© 2008 by the Infectious Diseases Society of America. All rights reserved.

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