BACKGROUND: Many HIV-infected patients on highly active antiretroviral therapy (HAART) experience metabolic complications including dyslipidaemia and insulin resistance, which may increase their coronary heart disease (CHD) risk. We developed a prognostic model for CHD tailored to the changes in risk factors observed in patients starting HAART. METHODS: Data from five cohort studies (British Regional Heart Study, Caerphilly and Speedwell Studies, Framingham Offspring Study, Whitehall II) on 13,100 men aged 40-70 and 114,443 years of follow up were used. CHD was defined as myocardial infarction or death from CHD. Model fit was assessed using the Akaike Information Criterion; generalizability across cohorts was examined using internal-external cross-validation. RESULTS: A parametric model based on the Gompertz distribution generalized best. Variables included in the model were systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, triglyceride, glucose, diabetes mellitus, body mass index and smoking status. Compared with patients not on HAART, the estimated CHD hazard ratio (HR) for patients on HAART was 1.46 (95% CI 1.15-1.86) for moderate and 2.48 (95% CI 1.76-3.51) for severe metabolic complications. CONCLUSIONS: The change in the risk of CHD in HIV-infected men starting HAART can be estimated based on typical changes in risk factors, assuming that HRs estimated using data from non-infected men are applicable to HIV-infected men. Based on this model the risk of CHD is likely to increase, but increases may often be modest, and could be offset by lifestyle changes.
BACKGROUND: Many HIV-infected patients on highly active antiretroviral therapy (HAART) experience metabolic complications including dyslipidaemia and insulin resistance, which may increase their coronary heart disease (CHD) risk. We developed a prognostic model for CHD tailored to the changes in risk factors observed in patients starting HAART. METHODS: Data from five cohort studies (British Regional Heart Study, Caerphilly and Speedwell Studies, Framingham Offspring Study, Whitehall II) on 13,100 men aged 40-70 and 114,443 years of follow up were used. CHD was defined as myocardial infarction or death from CHD. Model fit was assessed using the Akaike Information Criterion; generalizability across cohorts was examined using internal-external cross-validation. RESULTS: A parametric model based on the Gompertz distribution generalized best. Variables included in the model were systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, triglyceride, glucose, diabetes mellitus, body mass index and smoking status. Compared with patients not on HAART, the estimated CHD hazard ratio (HR) for patients on HAART was 1.46 (95% CI 1.15-1.86) for moderate and 2.48 (95% CI 1.76-3.51) for severe metabolic complications. CONCLUSIONS: The change in the risk of CHD in HIV-infected men starting HAART can be estimated based on typical changes in risk factors, assuming that HRs estimated using data from non-infected men are applicable to HIV-infected men. Based on this model the risk of CHD is likely to increase, but increases may often be modest, and could be offset by lifestyle changes.
Authors: Morris Schambelan; Peter W F Wilson; Kevin E Yarasheski; W Todd Cade; Victor G Dávila-Román; Ralph B D'Agostino; Tarek A Helmy; Matthew Law; Kristin E Mondy; Sharon Nachman; Linda R Peterson; Signe W Worm Journal: Circulation Date: 2008-06-19 Impact factor: 29.690
Authors: Stephen R Cole; Sonia Napravnik; Michael J Mugavero; Bryan Lau; Joseph J Eron; Michael S Saag Journal: Am J Epidemiol Date: 2009-12-09 Impact factor: 4.897
Authors: Kathy Petoumenos; Signe W Worm; Eric Fontas; Rainer Weber; Stephane De Wit; Mathias Bruyand; Peter Reiss; Wafaa El-Sadr; Antonella D'Arminio Monforte; Nina Friis-Møller; Jens D Lundgren; Matthew G Law Journal: J Int AIDS Soc Date: 2012-10-10 Impact factor: 5.396
Authors: Max Weyler Nery; Celina Maria Turchi Martelli; Erika Aparecida Silveira; Clarissa Alencar de Sousa; Marianne de Oliveira Falco; Aline de Cássia Oliveira de Castro; Jorge Tannus Esper; Luis Carlos Silva e Souza; Marília Dalva Turchi Journal: ScientificWorldJournal Date: 2013-10-21