Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease
Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease
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DOI：
10.1210/jc.2006-2190
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发表时间：
2007-07-01
影响因子：
5.8
通讯作者：
Grinspoon, Steven K.
中科院分区：
文献类型：
--
作者：
Triant, Virginia A.;Lee, Hang;Grinspoon, Steven K.
内容：代谢变化和吸烟在HIV患者中很常见，可能增加心血管风险。目的：本研究的目的是确定两所三级医院中HIV患者与非HIV患者相比的急性心肌梗死（AMI）率和心血管风险因素。设计、设置和参与者：我们进行了一项基于医疗保健系统的队列研究，使用了3，851名HIV和1，044，589名非HIV患者的大型数据登记。AMI发生率在1996年10月1日至2004年6月30日期间接受纵向护理的患者中确定。主要结果测量：主要结果是心肌梗死，由国际疾病分类编码标准确定。与非HIV患者相比，HIV患者每1000人-年的AMI发生率增加[11.13（95%置信区间[CI] 9.58-12.68）vs. 6.98（95% CI 6.89-7.06）]。HIV组的高血压（21.2 vs. 15.9%）、糖尿病（11.5 vs. 6.6%）和血脂异常（23.3 vs. 17.6%）的比例显著高于非HIV组（每次比较P < 0.0001）。HIV感染者与非HIV感染者的AMI发生率差异显著，校正年龄、性别、种族、高血压、糖尿病和血脂异常后的相对危险度（RR）为1.75（95%CI 1.51-2.02; P < 0.0001）。在性别分层模型中，女性艾滋病毒感染者每1000人-年的未校正AMI率较高（与非艾滋病毒感染者相比，女性艾滋病毒感染者为12.71 vs. 4.88），但男性艾滋病毒感染者每1000人-年的未校正AMI率并非如此（与非艾滋病毒感染者相比，男性艾滋病毒感染者为10.48 vs. 11.44）。调整年龄、性别、种族、高血压、糖尿病和血脂异常后，女性和男性的RR（HIV vs.非HIV）分别为2.98（95% CI 2.33-3.75; P < 0.0001）和1.40（95% CI 1.16-1.67; P = 0.0003）。该数据库的一个局限性是，它包含的吸烟数据不完整。吸烟不能包括在整体回归模型，和一些增加的风险可能是由吸烟rates.Conclusions的差异占：AMI率和心血管危险因素增加的艾滋病毒感染者与非艾滋病毒感染者相比，特别是女性。心脏风险调整策略对于HIV患者的长期护理非常重要。
Context: Metabolic changes and smoking are common among HIV patients and may confer increased cardiovascular risk.Objective: The aim of the study was to determine acute myocardial infarction (AMI) rates and cardiovascular risk factors in HIV compared with non-HIV patients in two tertiary care hospitals.Design, Setting, and Participants: We conducted a health care system-based cohort study using a large data registry with 3,851 HIV and 1,044,589 non-HIV patients. AMI rates were determined among patients receiving longitudinal care between October 1, 1996, and June 30, 2004.Main Outcome Measures: The primary outcome was myocardial infarction, identified by International Classification of Diseases coding criteria.Results: AMI was identified in 189 HIV and 26,142 non-HIV patients. AMI rates per 1000 person-years were increased in HIV vs. non-HIV patients [11.13 (95% confidence interval [CI] 9.58-12.68) vs. 6.98 ( 95% CI 6.89-7.06)]. The HIV cohort had significantly higher proportions of hypertension (21.2 vs. 15.9%), diabetes (11.5 vs. 6.6%), and dyslipidemia (23.3 vs. 17.6%) than the non-HIV cohort (P < 0.0001 for each comparison). The difference in AMI rates between HIV and non-HIV patients was significant, with a relative risk (RR) of 1.75 (95% CI 1.51-2.02; P < 0.0001), adjusting for age, gender, race, hypertension, diabetes, and dyslipidemia. In gender-stratified models, the unadjusted AMI rates per 1000 person-years were higher for HIV patients among women (12.71 vs. 4.88 for HIV compared with non-HIV women), but not among men (10.48 vs. 11.44 for HIV compared with non-HIV men). The RRs (for HIV vs. non-HIV) were 2.98 (95% CI 2.33-3.75; P < 0.0001) for women and 1.40 (95% CI 1.16-1.67; P = 0.0003) for men, adjusting for age, gender, race, hypertension, diabetes, and dyslipidemia. A limitation of this database is that it contains incomplete data on smoking. Smoking could not be included in the overall regression model, and some of the increased risk may be accounted for by differences in smoking rates.Conclusions: AMI rates and cardiovascular risk factors were increased in HIV compared with non-HIV patients, particularly among women. Cardiac risk modification strategies are important for the long-term care of HIV patients.