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HIV Raises Heart Disease Risk 60% in People Over 49
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XVIII International AIDS Conference, July 18-23, 2010, Vienna
Mark Mascolini
Limiting their analysis to people over 49 years old, German researchers determined that those with HIV had a 60% higher risk of cardiovascular disease than people without HIV or other severe chronic diseases [1]. The heart risk profile in the HIV group differed from both HIV-negative healthy people and from HIV-negative people with diabetes mellitus type 2.
The study focused on 561 people 50 or older, including 202 with HIV, 195 without HIV but with diabetes, and 164 people without severe chronic disease or malignancy (the controls). The investigators used the Framingham score to figure 10-year risk of cardiovascular disease in all study participants. They defined high risk as a score of 20% or higher or a history of coronary heart disease. The groups were similar in age with medians of 58 in the HIV group, 60 in the diabetes group, and 58 among controls. In the HIV and diabetes cohorts, 18% were women, compared with 21% of controls. Among people with HIV, 96% were taking antiretrovirals, 88% had a viral load below 50, 29% had AIDS, and median CD4 count was 525 (interquartile range [IQR] 371 to 701).
Rates of several risk factors differed between groups. Proportions with low-density lipoprotein cholesterol at or above 160 mg/dL were 22% with HIV, 13% with diabetes, and 26% in controls (P = 0.008). Proportions with low high-density lipoprotein cholesterol (below 35 mg/dL in men and 45 mg/dL in women) were 20% with HIV, 18% with diabetes, and 8% in controls (P = 0.004). Rates of total cholesterol at or above 240 mg/dL were 27% with HIV, 12% with diabetes, and 34% in controls (P < 0.001). Proportions taking lipid-lowering drugs were 20% with HIV, 43% with diabetes, and 20% in controls (P < 0.001). Proportions of people with a history of myocardial infarction or documented cardiovascular disease were 21% with HIV, 26% with diabetes, and 14% in controls (P = 0.018).
In the diabetes group, 69% were at high risk of cardiovascular disease, compared with 32% in the HIV group and 27% of controls. Looking at 10-year age brackets, the researchers found that people with diabetes had the highest proportions of people at risk among those in their 50s and those in their 60s. In the 60-to-69 group, almost 80% of those with diabetes were at high risk of cardiovascular disease, compared with about 50% of those with HIV and 30% of controls. Among people in their 70s, a significantly higher proportion of those with HIV (over 80%) than controls (about 40%) met the high-risk definition (P = 0.03).
In a multivariate analysis adjusted for age categories and presence of diabetes, people with HIV had a 60% higher risk of high-risk cardiovascular disease than people without HIV; people with diabetes had a 5 times higher risk than people without diabetes; and women had a 70% lower risk than men, as detailed by the following odds ratios (OR) and 95% confidence intervals (CI):
Risk of high-risk cardiovascular disease
-- HIV versus no HIV: OR 1.6, 95% CI 1.0 to 2.4, P = 0.05
-- Diabetes versus no diabetes: OR 4.8, 95% CI 3.1 to 7.3, P < 0.001
-- Women versus men: OR 0.3, 95% CI 0.2 to 0.5, P < 0.001
-- 60 to 69 versus 50 to 59: OR 2.8, 95% CI 1.8 to 4.3, P < 0.001
-- 70 to 79 versus 50 to 59: OR 5.3, 95% CI 2.8 to 10.0, P < 0.001
The researchers noted that the Framingham equation may underestimate heart disease risk in people with HIV.
References
1. Wolf E, Balogh A, Koegl C, et al. Excess cardiovascular risk in HIV+ patients aged over 50: results from the German 50/2010 cohort study in aging populations of HIV+ and HIV- patients. XVIII International AIDS Conference. July 18-23, 2010. Vienna. Abstract WEPE0043.
2. Law MG, Friis-Moller N, El-Sadr WM, et al; D:A:D Study Group. The use of the Framingham equation to predict myocardial infarctions in HIV-infected patients: comparison with observed events in the D:A:D Study. HIV Med. 2006;7:218-230.
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