HIV 感染与急性心肌梗死风险。
HIV infection and the risk of acute myocardial infarction.
机构信息
University of Pittsburgh School ofMedicine, Pittsburgh, PA 15213, USA.
出版信息
JAMA Intern Med. 2013 Apr 22;173(8):614-22. doi: 10.1001/jamainternmed.2013.3728.
IMPORTANCE
Whether people infected with human immunodeficiency virus (HIV) are at an increased risk of acute myocardial infarction (AMI) compared with uninfected people is not clear. Without demographically and behaviorally similar uninfected comparators and without uniformly measured clinical data on risk factors and fatal and nonfatal AMI events, any potential association between HIV status and AMI may be confounded.
OBJECTIVE
To investigate whether HIV is associated with an increased risk of AMI after adjustment for all standard Framingham risk factors among a large cohort of HIV-positive and demographically and behaviorally similar (ie, similar prevalence of smoking, alcohol, and cocaine use) uninfected veterans in care.
DESIGN AND SETTING
Participants in the Veterans Aging Cohort Study Virtual Cohort from April 1, 2003, through December 31, 2009.
PARTICIPANTS
After eliminating those with baseline cardiovascular disease, we analyzed data on HIV status, age, sex, race/ethnicity, hypertension, diabetes mellitus, dyslipidemia, smoking, hepatitis C infection, body mass index, renal disease, anemia, substance use, CD4 cell count, HIV-1 RNA, antiretroviral therapy, and incidence of AMI.
MAIN OUTCOME MEASURE
Acute myocardial infarction.
RESULTS
We analyzed data on 82 459 participants. During a median follow-up of 5.9 years, there were 871 AMI events. Across 3 decades of age, the mean (95% CI) AMI events per 1000 person-years was consistently and significantly higher for HIV-positive compared with uninfected veterans: for those aged 40 to 49 years, 2.0 (1.6-2.4) vs 1.5 (1.3-1.7); for those aged 50 to 59 years, 3.9 (3.3-4.5) vs 2.2 (1.9-2.5); and for those aged 60 to 69 years, 5.0 (3.8-6.7) vs 3.3 (2.6-4.2) (P < .05 for all). After adjusting for Framingham risk factors, comorbidities, and substance use, HIV-positive veterans had an increased risk of incident AMI compared with uninfected veterans (hazard ratio, 1.48; 95% CI, 1.27-1.72). An excess risk remained among those achieving an HIV-1 RNA level less than 500 copies/mL compared with uninfected veterans in time-updated analyses (hazard ratio, 1.39; 95% CI, 1.17-1.66).
CONCLUSIONS AND RELEVANCE
Infection with HIV is associated with a 50% increased risk of AMI beyond that explained by recognized risk factors.
重要性
与未感染的人相比，感染人类免疫缺陷病毒（HIV）的人是否有更高的急性心肌梗死（AMI）风险尚不清楚。如果没有在人口统计学和行为上相似的未感染对照组，也没有对危险因素以及致命和非致命性 AMI 事件进行统一测量的临床数据，那么 HIV 状态与 AMI 之间的任何潜在关联都可能存在混杂因素。
目的
在对大量感染 HIV 的患者和在人口统计学和行为上相似（即吸烟、饮酒和可卡因使用的流行率相似）的未感染退伍军人进行所有标准弗雷明汉风险因素调整后，调查 HIV 是否与 AMI 风险增加相关。
设计和设置
2003 年 4 月 1 日至 2009 年 12 月 31 日期间参加退伍军人老龄化队列研究虚拟队列的参与者。
参与者
在排除基线心血管疾病后，我们分析了 HIV 状态、年龄、性别、种族/族裔、高血压、糖尿病、血脂异常、吸烟、丙型肝炎感染、体重指数、肾脏疾病、贫血、物质使用、CD4 细胞计数、HIV-1 RNA、抗逆转录病毒治疗以及 AMI 发生率的数据。
主要结局测量
急性心肌梗死。
结果
我们分析了 82459 名参与者的数据。在中位随访 5.9 年期间，发生了 871 例 AMI 事件。在 3 个年龄组中，HIV 阳性退伍军人每 1000 人年的平均（95%CI）AMI 事件始终显著高于未感染的退伍军人：年龄在 40 至 49 岁的退伍军人为 2.0（1.6-2.4）比 1.5（1.3-1.7）；年龄在 50 至 59 岁的退伍军人为 3.9（3.3-4.5）比 2.2（1.9-2.5）；年龄在 60 至 69 岁的退伍军人为 5.0（3.8-6.7）比 3.3（2.6-4.2）（所有 P<0.05）。在调整弗雷明汉风险因素、合并症和物质使用后，与未感染的退伍军人相比，HIV 阳性退伍军人发生 AMI 的风险增加（风险比，1.48；95%CI，1.27-1.72）。在时间更新分析中，与未感染的退伍军人相比，HIV-1 RNA 水平低于 500 拷贝/mL 的 HIV 阳性退伍军人的风险仍有增加（风险比，1.39；95%CI，1.17-1.66）。
结论和相关性
感染 HIV 与 AMI 风险增加 50%相关，而这种风险增加超出了公认的风险因素解释的范围。
Zotero 插件