HIV and Coronary Heart Disease Time for a Better Understanding
HIV and Coronary Heart Disease Time for a Better Understanding
复制标题
DOI：
10.1016/j.jacc.2012.06.063
复制
发表时间：
2013-02-05
影响因子：
24
通讯作者：
Cohen, Ariel
中科院分区：
文献类型：
--
作者：
Boccara, Franck;Lang, Sylvie;Cohen, Ariel
心血管疾病，特别是冠心病，是艾滋病毒感染人群中一个新出现的令人关切的领域。自从出现有效的抗逆转录病毒疗法和随之而来的更长的患者寿命以来，与西方国家的一般人群相比，在艾滋病毒感染患者中观察到心肌梗死的风险增加。这种加速的动脉粥样硬化过程的病理生理学是复杂和多因素的。传统的心血管危险因素-在HIV人群中过度表达-与病毒复制不受控制和暴露于抗逆转录病毒药物（本身或通过脂质和葡萄糖紊乱）相关，可促进急性缺血性事件。因此，尽管成功的抗病毒治疗，许多研究表明，慢性炎症的作用，连同免疫激活，可能导致血管功能障碍和动脉粥样硬化血栓形成。现在是时候让医生通过使用普通人群中使用的工具来预防这一高危人群中的冠心病了。此外，艾滋病毒感染患者发生急性冠状动脉综合征的中位年龄较低，应将预防工作纳入患者
Cardiovascular disease, and particularly coronary heart disease, is an emerging area of concern in the HIV population. Since the advent of efficient antiretroviral therapies and the consequent longer patient life span, an increased risk for myocardial infarction has been observed in HIV-infected patients compared with the general population in Western countries. The pathophysiology of this accelerated atherosclerotic process is complex and multifactorial. Traditional cardiovascular risk factors-overrepresented in the HIV population-associated with uncontrolled viral replication and exposure to antiretroviral drugs (per se or through lipid and glucose disturbances) could promote acute ischemic events. Thus, despite successful antiviral therapy, numerous studies suggest a role of chronic inflammation, together with immune activation, that could lead to vascular dysfunction and atherothrombosis. It is time for physicians to prevent coronary heart disease in this high-risk population through the use of tools employed in the general population. Moreover, the lower median age at which acute coronary syndromes occur in HIV-infected patients should shift prevention to include patients