Class of antiretroviral drugs and the risk of myocardial infarction
Class of antiretroviral drugs and the risk of myocardial infarction
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DOI：
10.1056/nejmoa062744
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发表时间：
2007-04-26
影响因子：
158.5
通讯作者：
Lundgren, Jens D.
中科院分区：
文献类型：
--
作者：
Friis-Moller, Nina;Reiss, Peter;Lundgren, Jens D.
背景：我们先前已经证实了联合抗逆转录病毒治疗与心肌梗死风险之间的相关性。目前尚不清楚这种关联是否因抗逆转录病毒药物的类别而异。我们进行了一项研究，以探讨累积暴露于蛋白酶抑制剂和非核苷类逆转录酶抑制剂与心肌梗死的风险。方法：我们分析了2005年2月收集的数据，从我们的前瞻性观察性研究的23,437例感染人类免疫缺陷病毒。在随访期间的心肌梗死的发病率进行了计算，心肌梗死和暴露于蛋白酶抑制剂或非核苷类逆转录酶抑制剂之间的关联进行了determined.RESULTS：345例心肌梗死患者在94,469人年的观察。心肌梗死的发生率从未暴露于蛋白酶抑制剂的1.53/1000人-年增加到暴露于蛋白酶抑制剂超过6年的6.01/1000人-年。调整其他药物类别暴露和已确定的心血管风险因素后（不包括血脂水平），每年暴露于蛋白酶抑制剂的心肌梗死相对发生率为1.16（95%置信区间[CI]，1.10至1.23），而每年暴露于非核苷类逆转录酶抑制剂的相对比率为1.05（95% CI，0.98至1.13）。调整血脂水平进一步降低了暴露于每种药物类别的影响，分别为1.10（95%CI，1.04至1.18）和1.00（95%CI，0.93至1.09），respectively.CONCLUSIONS：增加蛋白酶抑制剂的暴露与心肌梗死的风险增加有关，这部分是由血脂异常解释的。我们没有发现与非核苷类逆转录酶抑制剂相关的证据;然而，暴露于此类药物的观察人年数少于暴露于蛋白酶抑制剂的观察人年数。
BACKGROUND:We have previously demonstrated an association between combination antiretroviral therapy and the risk of myocardial infarction. It is not clear whether this association differs according to the class of antiretroviral drugs. We conducted a study to investigate the association of cumulative exposure to protease inhibitors and nonnucleoside reverse-transcriptase inhibitors with the risk of myocardial infarction.METHODS:We analyzed data collected through February 2005 from our prospective observational study of 23,437 patients infected with the human immunodeficiency virus. The incidence rates of myocardial infarction during the follow-up period were calculated, and the associations between myocardial infarction and exposure to protease inhibitors or nonnucleoside reverse-transcriptase inhibitors were determined.RESULTS:Three hundred forty-five patients had a myocardial infarction during 94,469 person-years of observation. The incidence of myocardial infarction increased from 1.53 per 1000 person-years in those not exposed to protease inhibitors to 6.01 per 1000 person-years in those exposed to protease inhibitors for more than 6 years. After adjustment for exposure to the other drug class and established cardiovascular risk factors (excluding lipid levels), the relative rate of myocardial infarction per year of protease-inhibitor exposure was 1.16 (95% confidence interval [CI], 1.10 to 1.23), whereas the relative rate per year of exposure to nonnucleoside reverse-transcriptase inhibitors was 1.05 (95% CI, 0.98 to 1.13). Adjustment for serum lipid levels further reduced the effect of exposure to each drug class to 1.10 (95% CI, 1.04 to 1.18) and 1.00 (95% CI, 0.93 to 1.09), respectively.CONCLUSIONS:Increased exposure to protease inhibitors is associated with an increased risk of myocardial infarction, which is partly explained by dyslipidemia. We found no evidence of such an association for nonnucleoside reverse-transcriptase inhibitors; however, the number of person-years of observation for exposure to this class of drug was less than that for exposure to protease inhibitors.