Preclinical atherosclerosis due to HIV infection: carotid intima-medial thickness measurements from the FRAM study.
Preclinical atherosclerosis due to HIV infection: carotid intima-medial thickness measurements from the FRAM study.
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DOI：
10.1097/qad.0b013e32832d3b85
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发表时间：
2009-09-10
期刊：
影响因子：
--
通讯作者：
Kronmal RA
中科院分区：
文献类型：
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作者：
Grunfeld C;Delaney JA;Wanke C;Currier JS;Scherzer R;Biggs ML;Tien PC;Shlipak MG;Sidney S;Polak JF;O'Leary D;Bacchetti P;Kronmal RA
心血管疾病（CVD）是艾滋病毒感染者发病率和死亡率上升的原因。然而，HIV感染是否独立于传统心血管疾病危险因素导致动脉粥样硬化加速仍存在争议。HIV感染者和没有心血管疾病的对照组的横断面研究，来自HIV感染的脂肪再分布和代谢变化研究（FRAM）和动脉粥样硬化多种族研究（MESA）。在调整了传统的心血管疾病危险因素后，通过测量hiv感染者和对照组的颈动脉内/球和共同区域的颈动脉内膜-内侧厚度（IMT）来评估临床前动脉粥样硬化。对于颈内动脉，hiv感染者的平均IMT为1.17±0.50mm，对照组为1.06±0.58mm （p<0.0001）。在对人口统计学特征进行多变量调整后，hiv感染者与对照组的平均差异为+0.188mm （95%CI 0.113-0.263, p<0.0001）。对传统心血管疾病危险因素的进一步调整适度降低了HIV相关性（+0.148mm, 95%CI 0.072-0.224, p=0.0001）。对于颈总动脉，HIV感染与较大的IMT独立相关（+0.033mm, 95%CI 0.010, 0.056, p=0.005）。HIV感染与IMT的相关性与吸烟相似，吸烟也与较大的IMT相关（内+0.173mm，外+0.020mm）。即使在调整了传统的心血管疾病危险因素后，HIV感染仍伴随着IMT测量的更广泛的动脉粥样硬化。与颈总动脉相比，内/球区IMT与HIV感染的相关性更强，这可能解释了之前文献中的差异。HIV感染与IMT的关联与传统的心血管疾病危险因素（如吸烟）相似。
Cardiovascular disease (CVD) is an increasing cause of morbidity and mortality in HIV-infected patients. However, it is controversial whether HIV infection contributes to accelerated atherosclerosis independent of traditional CVD risk factors. Cross-sectional study of HIV-infected and control subjects without pre-existing CVD from the study of Fat Redistribution and Metabolic Change in HIV Infection (FRAM) and the Multi-Ethnic Study of Atherosclerosis (MESA). Pre-clinical atherosclerosis was assessed by carotid intima-medial thickness (IMT) measurements in the internal/bulb and common regions in HIV-infected and control subjects after adjusting for traditional CVD risk factors. For internal carotid, mean IMT was 1.17±0.50mm for HIV-infected participants and 1.06±0.58mm for controls (p<0.0001). After multivariable adjustment for demographic characteristics, the mean difference of HIV-infected vs. controls was +0.188mm (95%CI 0.113-0.263, p<0.0001). Further adjustment for traditional CVD risk factors modestly attenuated the HIV association (+0.148mm, 95%CI 0.072-0.224, p=0.0001). For the common carotid, HIV infection was independently associated with greater IMT (+0.033mm, 95%CI 0.010, 0.056, p=0.005). The association of HIV infection with IMT was similar to that of smoking which was also associated with greater IMT (internal +0.173mm, common +0.020mm). Even after adjustment for traditional CVD risk factors, HIV infection was accompanied by more extensive atherosclerosis measured by IMT. The stronger association of HIV infection with IMT in the internal/bulb region compared to the common carotid may explain previous discrepancies in the literature. The association of HIV infection with IMT was similar to that of traditional CVD risk factors, such as smoking.