INITIATIVE TO DECREASE CARDIOVASCULAR RISK AND INCREASE QUALITY OF CARE

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 通过成功的抗逆转录病毒治疗，感染人类免疫缺陷病毒（HIV）的患者寿命更长;然而，最近的报告表明，艾滋病毒感染者中冠心病（CHD）的发病率增加，1心血管疾病已成为这一人群发病和死亡的重要原因。2艾滋病毒感染者中CHD发病率增加可能与传统的风险因素有关，包括年龄增长，高吸烟率、血脂异常、胰岛素抵抗和葡萄糖耐量受损。心血管疾病也可能是由于非传统因素，包括身体成分的变化，一些患者的皮下脂肪减少和/或内脏脂肪堆积，炎症和病毒对血管系统的直接影响，以及特定抗逆转录病毒药物的直接影响。重要的问题仍然是艾滋病毒感染患者的心血管疾病和相关危险因素的发病机制，检测和治疗。这些问题涉及，除其他事项外，设计适当的试验，以确定冠心病的发病率和现有的冠心病筛查，预防，治疗和危险分层指南的效用。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. With successful antiretroviral therapy, patients infected with the human immunodeficiency virus (HIV) are living longer; however, recent reports suggest increased rates of coronary heart disease (CHD) among HIV-infected patients,1 and cardiovascular disease has become an important cause of morbidity and mortality in this population.2 Increased CHD rates in the HIV population may relate to traditional risk factors, including advancing age, higher smoking rates, dyslipidemia, insulin resistance, and impaired glucose tolerance. Cardiovascular disease may also be due to nontraditional factors, including changes in body composition with loss of subcutaneous fat and/or accumulation of visceral fat in some patients, inflammation, and direct effects of the virus on the vasculature, as well as to direct effects of specific antiretroviral drugs. Important questions remain as to the pathogenesis, detection, and treatment of cardiovascular disease and related risk factors in HIV-infected patients. These questions concern, among other things, the design of adequate trials to determine CHD incidence and the utility of existing CHD guidelines for screening, prevention, treatment, and risk stratification.