Published online before print February 2, 2009, doi: 10.1161/CIRCULATIONAHA.108.790857
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(Circulation. 2009;119:805-811.)
© 2009 American Heart Association, Inc.
Coronary Heart Disease |
Diabetes Mellitus, Preexisting Coronary Heart Disease, and the Risk of Subsequent Coronary Heart Disease Events in Patients Infected With Human Immunodeficiency Virus
The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D Study)
From Copenhagen HIV Programme (CHIP), University of Copenhagen (S.W.W., O.K., J.D.L., N.F.-M.), Copenhagen, Denmark; CHU Saint-Pierre Hospital, Department of Infectious Diseases (S.D.W.), Bruxelles, Belgium; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich (R.W.), Zurich, Switzerland; Research Department of Infection and Population Health (C.A.S.), UCL, London, United Kingdom; HIV Monitoring Foundation (P.R.), Academic Medical Center, Amsterdam, Netherlands; Columbia University/Harlem Hospital (W.E.-S.), New York, NY; Hospital San Paolo (A.D.M.), University of Milan, Milan, Italy; CHU Nice Hopital de l'Archet (E.F.), Nice, France; INSERM E0338 and U593 (F.D.), ISPED, Université Victor Segalen, Bordeaux, France; and National Centre in HIV Epidemiology and Clinical Research (M.G.L.), Sydney, Australia.
Correspondence to Signe W. Worm, MD, Copenhagen HIV Programme (CHIP), University of Copenhagen/Faculty of Health Science, Bldg 21.1/Blegdamsvej 3B, DK-2200 Copenhagen, Denmark. E-mail sww{at}cphiv.dk
Received May 22, 2008; accepted November 6, 2008.
Background— Although guidelines in individuals not infected with the human immunodeficiency virus (HIV) consider diabetes mellitus (DM) to be a coronary heart disease (CHD) equivalent, there is little information on its association with CHD in those infected with HIV. We investigated the impact of DM and preexisting CHD on the development of a new CHD episode among 33 347 HIV-infected individuals in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D Study).
Methods and Results— Over 159 971 person-years, 698 CHD events occurred. After adjustment for gender, age, cohort, HIV transmission, ethnicity, family history of CHD, smoking, and calendar year, the rate of a CHD episode was 7.52 times higher (Poisson regression, 95% CI 6.02 to 9.39, P=0.0001) in those with preexisting CHD than in those without preexisting CHD, but it was only 2.41 times higher (95% CI 1.91 to 3.05, P=0.0001) in those with preexisting DM compared with those without DM. No statistical interactions were apparent between either diagnosis and sex; although older people with DM had an increased CHD rate compared with younger people, older people with preexisting CHD had a lower event rate. A statistically significant interaction between preexisting DM and CHD (P=0.003) suggested that the CHD rate in those with preexisting CHD and DM is lower than expected on the basis of the main effects alone.
Conclusions— DM and preexisting CHD are both important risk factors for CHD events in HIV-infected individuals. There is a need for targeted interventions to reduce the risk of CHD in both high-risk groups of HIV-infected individuals.
CLINICAL PERSPECTIVE
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Clinical Summaries
Circulation 2009 119: 765-767.[Extract] [Full Text]