HIV infection and the risk of acute myocardial infarction.
HIV infection and the risk of acute myocardial infarction.
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DOI：
10.1001/jamainternmed.2013.3728
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发表时间：
2013-04-22
影响因子：
39
通讯作者：
Justice AC
中科院分区：
文献类型：
--
作者：
Freiberg MS;Chang CC;Kuller LH;Skanderson M;Lowy E;Kraemer KL;Butt AA;Bidwell Goetz M;Leaf D;Oursler KA;Rimland D;Rodriguez Barradas M;Brown S;Gibert C;McGinnis K;Crothers K;Sico J;Crane H;Warner A;Gottlieb S;Gottdiener J;Tracy RP;Budoff M;Watson C;Armah KA;Doebler D;Bryant K;Justice AC
与未感染者相比，感染人类免疫缺陷病毒（HIV）的人发生急性心肌梗死（AMI）的风险是否增加尚不清楚。如果没有人口统计学和行为学上相似的未感染对照品，也没有关于危险因素和致死性和非致死性AMI事件的统一测量的临床数据，HIV状态和AMI之间的任何潜在关联都可能受到混淆。在一个大的HIV阳性和人口统计学和行为学相似（即吸烟、饮酒和可卡因使用的相似流行率）的未感染的退伍军人队列中，研究在调整所有标准的Fragrance危险因素后，HIV是否与AMI风险增加相关。退伍军人老龄化队列研究虚拟队列的参与者，从2003年4月1日到2009年12月31日。在排除基线心血管疾病的患者后，我们分析了HIV状态、年龄、性别、种族/民族、高血压、糖尿病、血脂异常、吸烟、丙型肝炎感染、体重指数、肾脏疾病、贫血、物质使用、CD 4细胞计数、HIV-1 RNA、抗逆转录病毒治疗和AMI发病率的数据。急性心肌梗塞。我们分析了82459名参与者的数据。在平均5.9年的随访中，有871例AMI事件。在30岁时，与未感染的退伍军人相比，HIV阳性者每1000人-年的平均（95% CI）AMI事件持续且显著较高：对于40至49岁的退伍军人，2.0（1.6-2.4）对1.5（1.3-1.7）; 50至59岁的人，3.9（3.3-4.5）对2.2（1.9-2.5）; 60至69岁的人，5.0（3.8-6.7）对3.3（2.6-4.2）（所有P <0.05）。在调整了心脏病危险因素、合并症和药物使用后，与未感染的退伍军人相比，HIV阳性退伍军人发生AMI的风险增加（风险比，1.48; 95%CI，1.27-1.72）。在时间更新的分析中，与未感染的退伍军人相比，HIV-1 RNA水平低于500拷贝/mL的人群仍存在额外风险（风险比，1.39; 95%CI，1.17-1.66）。HIV感染与AMI风险增加50%相关，超出了公认的风险因素的解释。
Whether people infected with human immunodeficiency virus (HIV) are at an increased risk of acute myocardial infarction (AMI) compared with uninfected people is not clear. Without demographically and behaviorally similar uninfected comparators and without uniformly measured clinical data on risk factors and fatal and nonfatal AMI events, any potential association between HIV status and AMI may be confounded. To investigate whether HIV is associated with an increased risk of AMI after adjustment for all standard Framingham risk factors among a large cohort of HIV-positive and demographically and behaviorally similar (ie, similar prevalence of smoking, alcohol, and cocaine use) uninfected veterans in care. Participants in the Veterans Aging Cohort Study Virtual Cohort from April 1, 2003, through December 31, 2009. After eliminating those with baseline cardiovascular disease, we analyzed data on HIV status, age, sex, race/ethnicity, hypertension, diabetes mellitus, dyslipidemia, smoking, hepatitis C infection, body mass index, renal disease, anemia, substance use, CD4 cell count, HIV-1 RNA, antiretroviral therapy, and incidence of AMI. Acute myocardial infarction. We analyzed data on 82 459 participants. During a median follow-up of 5.9 years, there were 871 AMI events. Across 3 decades of age, the mean (95% CI) AMI events per 1000 person-years was consistently and significantly higher for HIV-positive compared with uninfected veterans: for those aged 40 to 49 years, 2.0 (1.6-2.4) vs 1.5 (1.3-1.7); for those aged 50 to 59 years, 3.9 (3.3-4.5) vs 2.2 (1.9-2.5); and for those aged 60 to 69 years, 5.0 (3.8-6.7) vs 3.3 (2.6-4.2) (P < .05 for all). After adjusting for Framingham risk factors, comorbidities, and substance use, HIV-positive veterans had an increased risk of incident AMI compared with uninfected veterans (hazard ratio, 1.48; 95% CI, 1.27-1.72). An excess risk remained among those achieving an HIV-1 RNA level less than 500 copies/mL compared with uninfected veterans in time-updated analyses (hazard ratio, 1.39; 95% CI, 1.17-1.66). Infection with HIV is associated with a 50% increased risk of AMI beyond that explained by recognized risk factors.