HIV, Cocaine Use, and Hepatitis C Virus: A Triad of Nontraditional Risk Factors for Subclinical Cardiovascular Disease
HIV, Cocaine Use, and Hepatitis C Virus: A Triad of Nontraditional Risk Factors for Subclinical Cardiovascular Disease
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DOI：
10.1161/atvbaha.116.307985
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发表时间：
2016-10-01
影响因子：
8.7
通讯作者：
Stein, James H.
中科院分区：
文献类型：
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作者：
Lucas, Gregory M.;Atta, Mohamed G.;Stein, James H.
目的 我们评估了 3 种非传统心血管疾病危险因素（HIV、可卡因使用和慢性丙型肝炎病毒感染）与 3 种经过验证的亚临床心血管疾病标志物（颈动脉斑块、白蛋白尿和主动脉脉搏波速度）在特征明确的队列中的横断面和纵向关联。方法和结果我们在基线和 24 个月后测量颈动脉斑块、每 6 个月的尿白蛋白/肌酐比以及每年测量脉搏波速度，持续时间长达对 292 名参与者（100 名 HIV 阴性和 192 名 HIV 阳性）的黑人群体进行了 36 个月的研究。 39% 的人患有慢性丙型肝炎病毒感染，分别有 20%、28% 和 52% 的人从未吸食过可卡因，过去吸过可卡因，现在吸过可卡因。在没有 1 种或 2 种或全部 3 种非传统危险因素的患者中，16%、47% 和 64% 有 2 种异常的心血管疾病风险标记（P=0.001）。在包含所有 3 个非传统危险因素的完全调整模型中，HIV 感染与颈动脉斑块进展（斑块解剖节段数量增加）、白蛋白尿（白蛋白肌酐比值 >30 mg/g）、白蛋白尿进展（白蛋白肌酐比值从基线加倍到值 >30 mg/g）和脉搏波速度独立相关。使用可卡因与基线时颈动脉斑块发生率增加约 3 倍相关，而丙型肝炎病毒感染与颈动脉斑块进展风险较高显着相关。 结论 这些结果表明，HIV 感染、可卡因使用和丙型肝炎病毒感染是心血管疾病的重要非传统危险因素，并强调需要了解这些关联的独特和重叠机制。
Objective We assessed cross-sectional and longitudinal associations of 3 nontraditional cardiovascular disease risk factorsHIV, cocaine use, and chronic hepatitis C virus infectionwith 3 validated markers of subclinical cardiovascular disease: carotid artery plaque, albuminuria, and aortic pulse wave velocity in a well-characterized cohort.Approach and Results We measured carotid plaque at baseline and after 24 months, urine albumin/creatinine ratio every 6 months, and pulse wave velocity annually for up to 36 months in a predominantly black cohort of 292 participants (100 HIV negative and 192 HIV positive). Thirty-nine percent had chronic hepatitis C virus infection and 20%, 28%, and 52% were never, past, and current cocaine users, respectively. Sixteen percent, 47%, and 64% of those with none, 1 or 2, or all 3 nontraditional risk factors had 2 abnormal cardiovascular disease risk markers (P=0.001). In fully adjusted models that included all 3 nontraditional risk factors, HIV infection was independently associated with carotid plaque progression (increase in the number of anatomic segments with plaque), albuminuria (albumin-creatinine ratio >30 mg/g), albuminuria progression (doubling of albumin-creatinine ratio from baseline to a value >30 mg/g), and pulse wave velocity. Cocaine use was associated with an approximate to 3-fold higher odds of carotid plaque at baseline, and hepatitis C virus infection was significantly associated with a higher risk of carotid plaque progression.Conclusions These results suggest that HIV infection, cocaine use, and hepatitis C virus infection are important nontraditional risk factors for cardiovascular disease and highlight the need to understand the distinct and overlapping mechanisms of the associations.