De Socio Giuseppe Vittorio L, Parruti Giustino, Quirino Tiziana, Ricci Elena, Schillaci Giuseppe, Adriani Beatrice, Marconi Patrizia, Franzetti Marzia, Martinelli Canio, Vichi Francesca, Penco Giovanni, Sfara Claudio, Madeddu Giordano, Bonfanti Paolo
Department of Infectious Diseases, Santa Maria Hospital, Perugia, Italy.
J Infect. 2008 Jul;57(1):33-40. doi: 10.1016/j.jinf.2008.03.007. Epub 2008 Apr 24.
To identify and characterize HIV-infected patients at higher cardiovascular risk in ordinary clinical settings.
Multicenter, nationwide cross-sectional study.
Consecutive HIV-patients, attending scheduled visits at facilities involved in the Italian coordination group for the study of allergies and HIV infection (CISAI), were included between February and April, 2005. Their 10-year probability of acute coronary events was calculated using the Framingham Risk Score (FRS) as well as 3 other cardiovascular algorithms ("PROCAM", "PROGETTO CUORE", "SCORE"); Metabolic Syndrome (MS) was diagnosed according to the National Cholesterol Education Program definitions. An estimated 10-year CVD >or=10% and/or MS led to the diagnosis of high CV risk. We compared selected clinical features between high- and low-risk patients.
A total of 1230 HIV infected patients (72% males, mean age of 43+/-9 years), 185 of whom treatment-naive, were evaluated. FRS gave the highest estimate of CV risk. The mean 10-year risk for acute coronary events according to FRS was 7.4+/-7.0. MS was present in 22% of the observed patients. Accordingly, 443 patients (36%) were classified at high risk. Twelve percent of the patients (n=142) had both a FRS >or=10% and a diagnosis of MS. The main single predictor of increased cardiovascular risk was smoking (60% of whole sample). A higher prevalence of clinically evident lipodystrophy and a higher CD4 T-cell counts were found both in patients with higher FRS and in patients with high FRS and MS (both p<0.001).
The worst estimation of CV risk was obtained with the FRS algorithm. Clinical evidence of lipodystrophy and higher CD4 T-cell counts were closely associated to a worse cardiovascular risk profile.
在普通临床环境中识别并描述心血管风险较高的HIV感染患者。
多中心、全国性横断面研究。
2005年2月至4月期间，纳入连续就诊于参与意大利过敏与HIV感染研究协调组（CISAI）的医疗机构的HIV患者。使用弗明汉风险评分（FRS）以及其他3种心血管算法（“PROCAM”、“PROGETTO CUORE”、“SCORE”）计算他们发生急性冠脉事件的10年概率；根据美国国家胆固醇教育计划的定义诊断代谢综合征（MS）。估计10年心血管疾病风险≥10%和/或患有MS可诊断为心血管高风险。我们比较了高风险和低风险患者的选定临床特征。
共评估了1230例HIV感染患者（72%为男性，平均年龄43±9岁），其中185例为初治患者。FRS对心血管风险的估计最高。根据FRS，急性冠脉事件的平均10年风险为7.4±7.0。22%的观察患者存在MS。因此，443例患者（36%）被归类为高风险。12%的患者（n = 142）FRS≥10%且诊断为MS。心血管风险增加的主要单一预测因素是吸烟（占整个样本的60%）。在FRS较高的患者以及FRS较高且患有MS的患者中，临床明显的脂肪代谢障碍患病率较高且CD4 T细胞计数较高（均p<0.001）。
FRS算法对心血管风险的估计最差。脂肪代谢障碍的临床证据和较高的CD4 T细胞计数与更差的心血管风险状况密切相关。
