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Published on: October 12, 2018
[Cardiovascular risk in human immunodeficiency virus-infected patients in Spain. CoRIS cohort, 2011]
Mar Masiá1, Santiago Pérez-Cachafeiro, María Leyes
1Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, España. marmasiac@gmail.com
Insights
Cardiovascular risk factors remain prevalent in Spanish HIV patients despite treatment. Standard risk scores underestimate the cardiovascular risk in this population.
Area of Science:
- Infectious Diseases
- Cardiology
- Public Health
Context:
- Limited data exists on cardiovascular risk (CVR) in HIV-infected patients in Spain.
- The study utilized the prospective multicentre Spanish HIV-infected patients cohort (CoRIS).
Purpose:
- To evaluate cardiovascular risk (CVR) in a Spanish HIV-infected cohort using Framingham, REGICOR, and SCORE equations.
- To assess the prevalence of modifiable CVR factors in HIV patients.
Summary:
- The study analyzed 1019 HIV patients, revealing high prevalence of modifiable CVR factors like smoking (46%) and low HDL cholesterol (36.1%).
- Antiretroviral therapy (ART) showed mixed effects on lipid profiles, while protease inhibitors (PIs) were associated with increased total cholesterol.
- Standard risk equations (Framingham, REGICOR, SCORE) identified a relatively low proportion of patients with moderate to high CVR (15.2%, 6.4%, 4.2%, 3.9% respectively).
Impact:
- Highlights the significant burden of cardiovascular risk factors in the Spanish HIV-infected population.
- Suggests that current risk assessment tools may underestimate CVR in HIV patients.
- Informs clinical practice and public health strategies for managing cardiovascular health in individuals with HIV.
Introduction:
Current information on cardiovascular risk (CVR) in HIV-infected patients in Spain is limited.
Methods:
An analysis was made of a prospective multicentre cohort of Spanish HIV-infected patients (CoRIS) between January-2010 and July-2011. CVR was evaluated using Framingham, REGICOR and SCORE equations.
Results:
The study included 1019 patients (76% males, mean age 40 years) recruited from 13 hospitals belonging to 10 autonomous communities in Spain. Almost two-thirds (65.4%) of patients were on antiretroviral therapy (ART), 36.7% with non-nucleoside analogs, 24% with protease inhibitors (PIs) (52% with atazanavir/r or darunavir/r) and 4,6% with raltegravir. More than half (56.2%) of the patients had an HIV viral load <50 copies/ml. Smoking prevalence was 46%, HDL cholesterol (HDL-C) <40mg/dl 36.1%, total cholesterol (total-C) >200mg/dl 27.8%, age >45years 27.2%, metabolic syndrome 11.5%, hypertension 9.4%, cocaine use 7%, and diabetes 2.9%. ART was associated with higher total-C and LDL-C concentrations, although also higher HDL-C and lower total-C/HDL-C ratio; patients receiving PIs boosted with a high ritonavir dose showed higher total-C levels and higher total-C/HDL-C ratio. According to Framingham cardiovascular, and coronary, REGICOR, and SCORE equations, 15.2%, 6.4%, 4.2% and 3.9% of patients, respectively, were classified as having moderate or high CVR.
Conclusion:
In HIV-infected patients from CoRIS, prevalence of modifiable CVR factors is still high. Commonly used scores identify a relatively low number of patients with high CVR.
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