Related Experiment Video
Updated: Apr 17, 2026
Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis
Published on: September 26, 2018
Baseline cardiovascular risk in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial
E Z Soliman1, S Sharma, K Arastéh
1Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston Salem, NC, USA.
Insights
Cardiovascular disease risk factors are common in individuals starting antiretroviral therapy, with significant geographical variations. Understanding these patterns is crucial for effective HIV management and cardiovascular disease prevention strategies.
Area of Science:
- Public Health
- Infectious Diseases
- Cardiology
Background:
- The Strategic Timing of AntiRetroviral Treatment (START) trial enrolled treatment-naïve individuals with high CD4 counts globally.
- Cardiovascular disease (CVD) is a significant concern in people with HIV.
- Baseline assessment of CVD risk factors is essential for understanding population health within HIV cohorts.
Purpose of the Study:
- To describe the prevalence and geographical distribution of cardiovascular disease (CVD) risk factors at baseline in the START trial.
- To identify common CVD risk factors among antiretroviral-naïve individuals with high CD4 counts.
- To explore regional differences in CVD risk factor prevalence.
Main Methods:
- Analysis of baseline data from 4019 START participants with electrocardiograms.
- Assessment of cardiovascular disease risk factors including smoking, hypertension, and obesity.
- Comparison of risk factor prevalence across geographical regions: North America, Europe/Australia/Israel, South America, Asia, and Africa.
Main Results:
- Over half of participants (58.3%) had at least one CVD risk factor; 18.9% had two or more.
- The most prevalent risk factors were current smoking (32%), hypertension (19.3%), and obesity (16.5%).
- Significant geographical variations in risk factor prevalence were observed, with North America having the highest (70.0%) and Asia the lowest (37.0%).
Conclusions:
- Cardiovascular disease risk factors are prevalent in this cohort of HIV-infected individuals starting treatment.
- The geographical distribution of these risk factors is uneven, highlighting the need for region-specific prevention strategies.
- Further research into the development and geographical patterns of CVD risk factors in people with HIV is warranted to inform prevention and treatment strategies.
Objectives:
The Strategic Timing of AntiRetroviral Treatment (START) trial has recruited antiretroviral-naïve individuals with high CD4 cell counts from all regions of the world. We describe the distribution of cardiovascular disease (CVD) risk factors, overall and by geographical region, at study baseline.
Methods:
The distribution of CVD risk factors was assessed and compared by geographical region among START participants who had a baseline electrocardiogram (n = 4019; North America, 11%; Europe/Australia/Israel, 36%; South America, 26%; Asia, 4%; Africa, 23%; median age 36 years; 26% female).
Results:
About 58.3% (n = 2344) of the participants had at least one CVD risk factor and 18.9% (n = 761) had two or more. The most common CVD risk factors were current smoking (32%), hypertension (19.3%) and obesity (16.5%). There were significant differences in the prevalence of CVD risk factors among geographical regions. The prevalence of at least one risk factor across regions was as follows: North America, 70.0%; Europe/Australia/Israel, 65.1%; South America, 49.4%; Asia, 37.0%; Africa, 55.8% (P-value < 0.001). Significant regional differences were also observed when risk factors were used as part of the Framingham and Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) risk scores or used to define a favourable risk profile.
Conclusions:
CVD risk factors are common among START participants, and their distribution varies by geographical region. Better understanding of how and why CVD risk factors develop in people with HIV infection and their geographical distributions could shed light on appropriate strategies for CVD prevention and may inform the interpretation of the results of START, as CVD is expected to be a major fraction of the primary endpoints observed.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:11Clinical Trials: Overview
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:15Bioavailability Study Design: Healthy Subjects Versus Patients