Effects of lifestyle modification and metformin on atherosclerotic indices among HIV-infected patients with the metabolic syndrome.
Effects of lifestyle modification and metformin on atherosclerotic indices among HIV-infected patients with the metabolic syndrome.
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DOI：
10.1097/qad.0b013e32834f33cc
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发表时间：
2012-03-13
期刊：
影响因子：
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通讯作者：
Grinspoon S
中科院分区：
文献类型：
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作者：
Fitch K;Abbara S;Lee H;Stavrou E;Sacks R;Michel T;Hemphill L;Torriani M;Grinspoon S
糖尿病、血脂异常、高血压和腹部肥胖等代谢异常常见于 HIV 患者，这些异常与冠状动脉钙化 (CAC) 增加相关，并导致该人群心血管疾病 (CVD) 增加。我们假设生活方式改变（LSM）和二甲双胍可以改善患有代谢综合征的 HIV 患者的 CVD 指数。一项随机、安慰剂对照试验，在 50 名患有代谢综合征的 HIV 感染患者中研究 LSM 和二甲双胍单独或联合使用一年多的情况。我们评估了 CAC、心血管和代谢指数。参与者中，HIV 感染持续时间为 14±1 年，抗逆转录病毒治疗持续时间为 6±1 年。二甲双胍治疗的受试者表现出显着较少的 CAC 进展（-1±2 与 33±17，P=0.004，二甲双胍与安慰剂相比），而 LSM 对 CAC 进展的影响并不显着（8±6 与 21±14，P=0.82，LSM 与无 LSM）。二甲双胍对 CAC 的影响显着大于 LSM（P=0.01）。与安慰剂相比，二甲双胍治疗的受试者也表现出钙化斑块体积进展较小（-0.4±1.9 vs. 27.6±13.8 mm3，P=0.008），并且 HOMA-IR 有所改善（P=0.05）。随机接受 LSM 的受试者与未接受 LSM 的受试者相比，HDL (P=0.03)、hsCRP (P=0.05) 和心肺健康水平显着改善。 4组间CAC变化：1）无LSM，安慰剂（43±30）； 2) LSM、安慰剂(19±7)； 3)无LSM、二甲双胍(1±1)； 4) LSM、二甲双胍 (−4±6) 不同（方差分析 P=0.03 和组间线性趋势），这种效应大部分是由二甲双胍介导的。结果为平均值±SEM。二甲双胍可预防患有代谢综合征的艾滋病毒感染患者的斑块进展。
Metabolic abnormalities including diabetes, dyslipidemia, hypertension, and abdominal obesity occur commonly in HIV patients, are associated with increased coronary artery calcification (CAC), and contribute to increased cardiovascular disease (CVD) in this population. We hypothesized that lifestyle modification (LSM) and metformin would improve CVD indices in HIV patients with metabolic syndrome. A randomized, placebo controlled trial to investigate LSM and metformin, alone and in combination, over one year, among 50 HIV-infected patients with metabolic syndrome. We assessed CAC, cardiovascular and metabolic indices. Among the participants, duration of HIV-infection was 14±1 yr and duration of antiretroviral therapy was 6±1 yr. Metformin-treated subjects demonstrated significantly less progression of CAC (−1±2 vs. 33±17, P=0.004, metformin vs. placebo) whereas the effect of LSM on CAC progression was not significant (8±6 vs. 21±14, P=0.82, LSM vs. no LSM). Metformin had a significantly greater effect on CAC than LSM (P=0.01). Metformin-treated subjects also demonstrated less progression in calcified plaque volume (−0.4±1.9 vs. 27.6±13.8 mm3, P=0.008) and improved HOMA-IR (P=0.05) compared to placebo. Subjects randomized to LSM vs. no LSM showed significant improvement in HDL (P=0.03), hsCRP (P=0.05), and cardiorespiratory fitness. Changes in CAC among the 4 groups: 1) no LSM, placebo (43±30); 2) LSM, placebo (19±7); 3) no LSM, metformin (1±1); and 4) LSM, metformin (−4±6) were different (P=0.03 for ANOVA and linear trend across groups), the majority of this effect was mediated by metformin. Results are mean ± SEM. Metformin prevents plaque progression in HIV-infected patients with the metabolic syndrome.