De Socio Giuseppe Vittorio L, Martinelli Laura, Morosi Sabrina, Fiorio Maurizio, Roscini Anna Rita, Stagni Giuliano, Schillaci Giuseppe
Unit of Infectious Diseases, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy.
Scand J Infect Dis. 2007;39(9):805-12. doi: 10.1080/00365540701230884.
Cardiovascular disease (CVD) is an increasing concern for human immunodeficiency virus (HIV)-infected patients, and risk assessment is recommended in routine HIV care. The absolute cardiovascular risk in an individual is determined by several factors, and various algorithms may be applied. To date, few comparisons of HIV patients with persons of the same age from the general population have been conducted. We hypothesized that the calculated risk of CVD may be increased in HIV patients. The probability for acute coronary events within 10 y (Framingham Risk Score) and the probability for fatal cardiovascular disease (SCORE algorithm) were assessed in 403 consecutive HIV-positive subjects free from overt cardiovascular disease, as well as in 96 age- and gender-matched control subjects drawn from the general population living in the same geographical area. The average 10-y risk for acute coronary events (Framingham Risk Score) was 7.0%+/-5% in HIV subjects and 6.3%+/-5% in the control group (p =0.32). The 10-y estimated risk for cardiovascular mortality (SCORE algorithm) was 1.23%+/-2.3% and 0.83%+/-0.9%, respectively (p =0.01). The main contributor to the increased CVD risk was the high proportion of smokers, but not an increase in cholesterol level. In conclusion, a limited increase in estimated risk of CVD was found in HIV-infected patients compared to the general population. In HIV-infected individuals other factors of less value in the general population and not included in any cardiovascular algorithm might be important. In our patients intervention to modify traditional risk factors should be addressed primarily towards modifying smoking habits.
心血管疾病（CVD）日益成为人类免疫缺陷病毒（HIV）感染患者关注的问题，因此建议在常规HIV护理中进行风险评估。个体的绝对心血管风险由多种因素决定，可以应用各种算法。迄今为止，很少有研究对HIV患者与普通人群中同年龄段的人进行比较。我们假设HIV患者中计算出的CVD风险可能会增加。对403名无明显心血管疾病的连续HIV阳性受试者以及从同一地理区域的普通人群中抽取的96名年龄和性别匹配的对照受试者，评估了10年内急性冠状动脉事件的概率（弗明汉姆风险评分）和致命心血管疾病的概率（SCORE算法）。HIV受试者急性冠状动脉事件的平均10年风险（弗明汉姆风险评分）为7.0%±5%，对照组为6.3%±5%（p = 0.32）。心血管死亡率的10年估计风险（SCORE算法）分别为1.23%±2.3%和0.83%±0.9%（p = 0.01）。CVD风险增加的主要因素是吸烟者比例高，而非胆固醇水平升高。总之，与普通人群相比，HIV感染患者的CVD估计风险仅有有限增加。在HIV感染个体中，普通人群中价值较小且未包含在任何心血管算法中的其他因素可能很重要。对于我们的患者，改变传统风险因素的干预措施应主要针对改变吸烟习惯。
