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Metabolic Syndrome Does Not Up Death Risk in HIV Cohort--But Bad Lipids Do
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15th Conference on Retroviruses and Opportunistic Infections
February 3-6, 2008
Boston
Mark Mascolini
Metabolic syndrome--a constellation of conditions that makes death more likely in the general population--did not heighten the all-cause death risk in the US Nutrition for Healthy Living (NHL) cohort [1]. But high triglycerides and low high-density lipoprotein (HDL) cholesterol each doubled the death risk.
NHL investigators ran a survival analysis on 557 cohort members seen from 1995 through 2005, focusing how many had metabolic syndrome. They diagnosed the syndrome in people with at least three of the following five features: (1) waist circumference above 102 cm in men and above 88 cm in women, (2) triglycerides above 150 mg/dL, (3) HDL cholesterol below 40 mg/dL in men and below 50 mg/dL in women, (4) blood pressure at or above 130/85 mm Hg, and (5) fasting glucose at or above 100 mg/dL. A physician panel determined the cause of death based on medical records, death certificate, or both.
During the observation period 62 people (11%) died, 30 (48%) from non-AIDS causes including cardiovascular disease in 1, stroke in 2, infection in 2, and cancer in 6. Seven people died of substance abuse and 4 from trauma. Twenty-four people (39%) died of AIDS, while causes of death remained undetermined in 8 people.
Three variables distinguished people who died from survivors.
· Twenty-six people (44.1%) who died versus 82 (16.8%) who survived had a CD4 count below 200 (P < 0.001).
· Serum albumin was significantly lower in people who died (3.62 mg/dL) than in those who did not (3.95 mg/dL) (P < 0.001).
· Forty-four people who died (74.6%) versus 288 survivors (59.4%) had an HDL cholesterol reading below the cutoffs for metabolic syndrome (P = 0.024)
Multivariate analysis adjusted for death risk factors in people with HIV and in earlier metabolic syndrome studies found only two variables--both of them lipid parameters--that independently raised the risk of death:
· Triglycerides above 150 mg/dL almost doubled the death risk (adjusted hazard ratio [AHR] 1.75, P = 0.048).
· "Good" HDL cholesterol below 40 mg/dL in men and below 50 mg/dL in women more than doubled the death risk (AHR 2.23, P = 0.012).
Blood pressure at or above 130/85 mm Hg heightened the risk of dying more than 50% (AHR 1.54), but that correlation fell short of statistical significance (P = 0.13).
These findings differ from results in general-population studies, which have linked metabolic syndrome to inflated odds of cardiovascular or all-cause mortality [2,3]. In this HIV cohort metabolic syndrome raised the all-cause death risk 43% (AHR 1.43), but that correlation lacked statistical significance (P = 0.19). The NHL investigators noted that follow-up longer than the median 53.2 months in this analysis may discern a link between metabolic syndrome and death in people with HIV. Or perhaps that correlation would emerge in an analysis of a larger population.
Gender, race, and current smoking status did not make death more likely in the NHL cohort. Because high triglycerides and low HDL cholesterol affect treated and untreated people with HIV, the investigators call for further research to see if modifying those risk factors improves survival in infected people.
References
1. Jarrett O, Ruthazer R, Knox T, Wanke C, et al. Metabolic risk factors for mortality in HIV+ patients. 15th Conference on Retroviruses and Opportunistic Infections. February 3-6, 2008. Boston. Abstract 950.
2. Malik S, Wong ND, Franklin SS, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004;110:1245-1250.
3. Lakka HM, Laaksonen DE, Lakka TA, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288:2709-2716.
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