Friis-Møller Nina, Thiébaut Rodolphe, Reiss Peter, Weber Rainer, Monforte Antonella D'Arminio, De Wit Stephane, El-Sadr Wafaa, Fontas Eric, Worm Signe, Kirk Ole, Phillips Andrew, Sabin Caroline A, Lundgren Jens D, Law Matthew G
Copenhagen HIV Programme (CHIP), University of Copenhagen/Faculty of Health Science, Copenhagen, Denmark.
Eur J Cardiovasc Prev Rehabil. 2010 Oct;17(5):491-501. doi: 10.1097/HJR.0b013e328336a150.
HIV-infected patients receiving combination antiretroviral therapy may experience metabolic complications, potentially increasing their risk of cardiovascular diseases (CVDs). Furthermore, exposures to some antiretroviral drugs seem to be independently associated with increased CVD risk. We aimed to develop cardiovascular risk-assessment models tailored to HIV-infected patients.
Prospective multinational cohort study. The data set included 22,625 HIV-infected patients from 20 countries in Europe and Australia who were free of CVD at entry into the Data collection on Adverse Effects of Anti-HIV Drugs Study. Using cross-validation methods, separate models were developed to predict the risk of myocardial infarction, coronary heart disease, and a composite CVD endpoint. Model performance was compared with the Framingham score. The models included age, sex, systolic blood pressure, smoking status, family history of CVD, diabetes, total cholesterol, HDL cholesterol and indinavir, lopinavir/r and abacavir exposure. The models performed well with area under the receiver operator curve statistics of 0.783 (range 0.642-0.820) for myocardial infarction, 0.776 (0.670-0.818) for coronary heart disease and 0.769 (0.695-0.824) for CVD. The models estimated more accurately the outcomes in the subgroups than the Framingham score.
Risk equations developed from a population of HIV-infected patients, incorporating routinely collected cardiovascular risk parameters and exposure to individual antiretroviral therapy drugs, might be more useful in estimating CVD risks in HIV-infected persons than conventional risk prediction models.
接受联合抗逆转录病毒治疗的HIV感染患者可能会出现代谢并发症，从而潜在地增加其患心血管疾病（CVD）的风险。此外，接触某些抗逆转录病毒药物似乎与CVD风险增加独立相关。我们旨在开发针对HIV感染患者的心血管风险评估模型。
前瞻性跨国队列研究。数据集包括来自欧洲和澳大利亚20个国家的22625名HIV感染患者，这些患者在进入抗HIV药物不良反应数据收集研究时无CVD。使用交叉验证方法，开发了单独的模型来预测心肌梗死、冠心病和复合CVD终点的风险。将模型性能与弗雷明汉评分进行比较。模型包括年龄、性别、收缩压、吸烟状况、CVD家族史、糖尿病、总胆固醇、高密度脂蛋白胆固醇以及茚地那韦、洛匹那韦/利托那韦和阿巴卡韦的暴露情况。模型表现良好，心肌梗死的受试者工作特征曲线下面积统计值为0.783（范围0.642 - 0.820），冠心病为0.776（0.670 - 0.818），CVD为0.769（0.695 - 0.824）。与弗雷明汉评分相比，模型在亚组中对结局的估计更准确。
从HIV感染患者群体中开发的风险方程，纳入常规收集的心血管风险参数和个体抗逆转录病毒治疗药物的暴露情况，在估计HIV感染者的CVD风险方面可能比传统风险预测模型更有用。
