Shahmanesh Maryam, Schultze Anna, Burns Fiona, Kirk Ole, Lundgren Jens, Mussini Cristina, Pedersen Court, De Wit Stephane, Kutsyna Galyna, Mocroft Amanda
aResearch Department of Infection and Population Health, University College London, London, United Kingdom bCHIP, Department of Infectious Diseases, Rigshospitalet University of Copenhagen, Copenhagen, Denmark cUniversita Modena, Modena, Italy dOdense University Hospital, Odense, Denmark eSaint-Pierre Hospital, Université Libre de Bruxelles, Brussels, Belgium fLuhansk State Medical University; Luhansk, Ukraine.
AIDS. 2016 Oct 23;30(16):2505-2518. doi: 10.1097/QAD.0000000000001207.
HIV has become a chronic condition associated with comorbidities. We investigated cardiovascular risk and risk modification in a European HIV cohort.
EuroSIDA patients (from 1 January 2000) for whom cardiovascular risk could be calculated (DAD risk equation) were included in the analysis. Moderate-to-high risk was defined as 5-year cardiovascular risk more than 5% and risk modification as two measurements meeting the European AIDS Clinical Society guidelines. Factors associated with risk development and modifications were investigated using Poisson regression.
Of 8762 individuals, 32.1% were hypertensive, 45.0% had high cholesterol, 47.4% were current smokers, and 27.1% were overweight. A total of 1504 (17.2%) had a 5-year cardiovascular risk of more than 5%. Of 7258 individuals with a 5-year risk less than 5%, 1905 (26.2%) developed cardiovascular risk more than 5% (6.53/100 person-years). These patients were more likely to be older, men, living in East Europe, with traditional cardiovascular risk factors. MSM with longer exposure to antiretroviral therapy, low CD4 nadir, higher current CD4 and prior AIDs events were more likely to develop cardiovascular risk. Those on antihypertensive treatment and living in central Europe were less likely to develop cardiovascular risk. Of those clinically indicated for risk modification, 1205 of 2077 (58.0%) successfully modified BP; 1283 of 3919 (32.8%) stopped smoking; 277 of 1394 (19.9%) modified cholesterol and 543 of 2163 (25.1%) reduced their BMI. There was variation in modification of individual risk factors, by sex, age, HIV-related factors and region of follow-up. Risk modification for BP and smoking improved over time (P < 0.001).
Cardiovascular risk was common. More than half modified their cardiovascular risk, and this improved over time.
人类免疫缺陷病毒（HIV）已成为一种与多种合并症相关的慢性病。我们在一个欧洲HIV队列中调查了心血管疾病风险及风险修正情况。
纳入分析的是欧洲艾滋病临床研究数据库（EuroSIDA）中从2000年1月1日起可计算心血管疾病风险（使用DAD风险方程）的患者。中度至高度风险定义为5年心血管疾病风险超过5%，风险修正定义为两项测量结果符合欧洲艾滋病临床学会指南。使用泊松回归分析与风险发展及修正相关的因素。
在8762名个体中，32.1%患有高血压，45.0%胆固醇水平高，47.4%为当前吸烟者，27.1%超重。共有1504人（17.2%）5年心血管疾病风险超过5%。在5年风险低于5%的7258名个体中，有1905人（26.2%）发展为心血管疾病风险超过5%（6.53/100人年）。这些患者更可能年龄较大、为男性、生活在东欧，且具有传统心血管疾病风险因素。接受抗逆转录病毒治疗时间较长、CD4最低点较低、当前CD4较高以及既往有艾滋病事件的男男性行为者（MSM）更可能发展为心血管疾病风险。接受抗高血压治疗且生活在中欧的患者发展为心血管疾病风险的可能性较小。在临床上需要进行风险修正的患者中，2077人中有1205人（58.0%）成功修正了血压；3919人中有1283人（32.8%）戒烟；1394人中有277人（19.9%）修正了胆固醇水平，2163人中有543人（25.1%）降低了体重指数。个体风险因素的修正存在性别、年龄、HIV相关因素及随访地区的差异。血压和吸烟的风险修正情况随时间有所改善（P<0.001）。
心血管疾病风险很常见。超过一半的人修正了他们的心血管疾病风险，且这一情况随时间有所改善。
