Cardiovascular Disease Risk Factor Control in People With and Without Human Immunodeficiency Virus.
Cardiovascular Disease Risk Factor Control in People With and Without Human Immunodeficiency Virus.
复制标题
感染和未感染人类免疫缺陷病毒的人的心血管疾病危险因素控制。
DOI：
10.1093/cid/ciad728
复制
发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Horberg,Michael
中科院分区：
文献类型：
--
作者：
Silverberg,MichaelJ;Levine,ToryM;Lea,AlexandraN;Williams,AndrewE;Alexeeff,StaceyE;Bryant,Kendall;Cavassini,Matthias;Flamm,JasonA;Hare,CBradley;Ingle,SuzanneM;Justice,AmyC;Lam,JenniferO;Sterling,StacyA;Horberg,Michael
与无HIV感染者（PWoH）相比，对高血压、血脂异常、糖尿病和其他可变因素的控制可能会降低HIV感染者患心血管疾病（CVD）的风险。使用一种新型疾病管理指数（DMI）测量风险因素控制，该指数解释了治疗目标以上的量/持续时间（0%至100% [完美控制]），包括2种高血压（舒张压和收缩压）DMI、3种血脂异常（低密度脂蛋白、总胆固醇、甘油三酯）DMI和1种糖尿病（HbA 1c）DMI。CVD风险的HIV状态进行了评估，并在调整后的考克斯比例hazardsmodel.ResultsPWH和PWoH有类似的DMIs（80%-100%），除了甘油三酯（更糟糕的PWH）和HbA 1c（更好的PWH）的亚组定义的DMIs，吸烟，饮酒，超重/肥胖。在校正模型中，PWH与PWoH相比，CVD风险升高（风险比[HR]，1.18; 95%置信区间[CI]，1.07-1.31）。这种关联在血脂异常和糖尿病得到控制的亚组中减弱，但在高血压得到控制或总胆固醇较高的PWH中仍然升高。最强的艾滋病毒状态与心血管疾病的关联被认为是在亚组中经常使用不健康的酒精（HR，2.13; 95%CI，1.04-4.34）。艾滋病毒和心血管疾病与频繁使用不健康的酒精密切相关，这表明有必要加强对威尔斯亲王医院酒精问题的筛查和治疗。
BackgroundManagement of hypertension, dyslipidemia, diabetes and other modifiable factors may mitigate the cardiovascular disease (CVD) risk in people with human immunodeficiency virus (HIV, PWH) compared with people without HIV (PWoH).MethodsThis was a retrospective cohort study of 8285 PWH and 170 517 PWoH from an integrated health system. Risk factor control was measured using a novel disease management index (DMI) accounting for amount/duration above treatment goals (0% to 100% [perfect control]), including 2 DMIs for hypertension (diastolic and systolic blood pressure), 3 for dyslipidemia (low-density lipoprotein, total cholesterol, triglycerides), and 1 for diabetes (HbA1c). CVD risk by HIV status was evaluated overall and in subgroups defined by DMIs, smoking, alcohol use, and overweight/obesity in adjusted Cox proportional hazards models.ResultsPWH and PWoH had similar DMIs (80%–100%) except for triglycerides (worse for PWH) and HbA1c (better for PWH). In adjusted models, PWH had an elevated risk of CVD compared with PWoH (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.07–1.31). This association was attenuated in subgroups with controlled dyslipidemia and diabetes but remained elevated for PWH with controlled hypertension or higher total cholesterol. The strongest HIV status association with CVD was seen in the subgroup with frequent unhealthy alcohol use (HR, 2.13; 95% CI, 1.04–4.34).ConclusionsControl of dyslipidemia and diabetes, but not hypertension, attenuated the HIV status association with CVD. The strong association of HIV and CVD with frequent unhealthy alcohol use suggests enhanced screening and treatment of alcohol problems in PWH is warranted.