Cardiac risk: not so simple.
Cardiac risk: not so simple.
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心脏风险：没那么简单。
DOI：
10.1086/649898
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Ribaudo,Heather
中科院分区：
文献类型：
--
作者：
Aberg,JudithA;Ribaudo,Heather
了解人类免疫缺陷病毒（HIV）感染者心血管疾病的风险是复杂的。关于有多少风险可归因于宿主遗传、传统风险因素、抗逆转录病毒治疗的不良反应以及与HIV本身相关的炎症状态，存在争议。然而，在普通人群中进行的INTERHEART研究[2]清楚地表明，心血管危险因素之间存在协同作用，因此，2个或2个以上危险因素（如高血压和血脂异常）共同出现，可能对总体心血管风险产生大于相加的影响。因此，在管理艾滋病毒感染者时，需要考虑所有可能导致冠心病的因素。确定艾滋病毒感染者风险的困难主要是由于缺乏匹配的对照、样本量小、缺乏标准化定义，以及艾滋病毒本身的未知贡献。此前，抗hiv药物不良事件数据收集（D: A: D）研究人员报道，累积使用蛋白酶抑制剂会增加心肌梗死（MI）的相对发病率（RR）（每年暴露的RR， 1.16[95%可信区间{CI}， 1.10-1.23]），但非核苷类逆转录酶抑制剂（每年暴露的RR， 1.05 [95% CI, 0.98-1.13]）不会增加。在随后对核苷逆转录酶抑制剂使用的分析中，发现近期使用阿巴卡韦（RR, 1.90 [95% CI, 1.47-2.45]）和二腺苷（RR, 1.49 [95% CI, 1.14-1.95]）会意外增加心肌梗死的风险，但累积使用[3]不会增加心肌梗死的风险。当时对该研究的批评是，阿巴卡韦优先用于患有代谢综合征、脂肪萎缩、血脂异常、肾脏疾病和冠心病的患者，研究结果反映了提供者的处方偏差，特别是考虑到评估替诺福韦效果的时间不足，替诺福韦是一种与阿巴卡韦类似的核苷酸，但用于肾脏疾病患者。Worm等人在本期《杂志》上发表的一项研究中，对该队列进行了1年的随访，D: a: D研究人员能够发现
Understanding the risk of cardiovascular disease in persons with human immunodeficiency virus (HIV) infection is complex. Controversy exists as to how much risk can be attributed to host genetics, traditional risk factors, adverse effects from antiretroviral therapy, and the inflammatory state associated with HIV itself [1]. Nevertheless, the INTERHEART study [2], conducted in the general population, clearly suggests there is synergy among cardiovascular risk factors, such that the co-occurrence of 2 or more risk factors (eg, hypertension and dyslipidemia), may have greater-than-additive effects on overall cardiovascular risk. Thus, all factors potentially contributing to coronary heart disease (CHD) need to be considered when managing persons infected withHIV. The difficulties in determining risks among those with HIV infection have largely been due to the lack of matched controls, small sample size, and lack of standardized definitions, plus the unknown contribution from HIV itself. Previously, the Data Collection on Adverse Events of Anti-HIV Drugs (D: A: D) investigators reported an increased relative rate (RR) of myocardial infarction (MI) with cumulative use of protease inhibitors (RR per year of exposure, 1.16 [95% confidence interval {CI}, 1.10–1.23]) but not nonnucleoside reverse-transcriptase inhibitors (RR per year of exposure, 1.05 [95% CI, 0.98–1.13]). In a subsequent analysis focusing on nucleoside reversetranscriptase inhibitor use, an unexpected increased risk of MI was found with recent use of abacavir (RR, 1.90 [95% CI, 1.47–2.45]) and didanosine (RR, 1.49 [95% CI, 1.14–1.95]), but not with cumulative use [3]. Criticism of the study at that time was that abacavir had been preferentially prescribed to those with metabolic syndromes, lipoatrophy, dyslipidemia, renal disease, and CHD and that the study results reflected provider prescribing bias, especially given that there was an inadequate duration of time to evaluate the effects of tenofovir, a nucleotide similarly prescribed as abacavir except among those with renal disease. In a study by Worm et al [4] in this issue of the Journal, with 1 additional year of follow-up of the cohort, the D: A: D investigators were able to ex-
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影响因子：
6.4
作者：
Worm, Signe Westring;Sabin, Caroline;Lundgren, Jens
通讯作者：
Lundgren, Jens
影响因子：
158.5
作者：
Friis-Moller, Nina;Reiss, Peter;Lundgren, Jens D.
通讯作者：
Lundgren, Jens D.
影响因子：
6.3
作者：
Hern치n, MA
通讯作者：
Hern치n, MA
影响因子：
5.4
作者：
Hernán, MA;Brumback, B;Robins, JM
通讯作者：
Robins, JM
DOI：
10.1097/qai.0b013e31819ff0e6
发表时间：
2009-05-01
影响因子：
3.6
作者：
Brothers, Cindy H.;Hernandez, Jaime E.;Lapierre, Didier H.
通讯作者：
Lapierre, Didier H.