基于现金的应急管理干预对合并HIV相关亚临床冠状动脉粥样硬化的可卡因使用者高危冠状动脉斑块的消退作用
High-risk Coronary Plaque Regression in Cash-based Contingency Management Intervention Among Cocaine Users With HIV-associated Subclinical Coronary Atherosclerosis.
作者信息
Lai Hong, Bluemke David A, Fishman Elliot K, Gerstenblith Gary, Celentano David D, Treisman Glenn, Foster Parker, Mandler Raul, Khalsa Jag, Chen Shaoguang, Bhatia Sandeepan, Kolossváry Márton, Lai Shenghan
机构信息
From the Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD (HL, EKF, SL); Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD (HL, JK, SL); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI (DAB); Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (GG, SL); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (DDC, SL); Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD (GT, SL); Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, WI (PF); National Institute on Drug Abuse, Rockville, MD (RM); Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD (MK, SL).
出版信息
J Addict Med. 2023;17(2):147-154. doi: 10.1097/ADM.0000000000001057. Epub 2022 Aug 24.
BACKGROUND
Cocaine use exacerbates human immunodeficiency virus (HIV)-associated subclinical coronary atherosclerosis. We investigated whether cocaine abstinence or reduced use achieved with contingency management (CM) intervention would retard high-risk coronary plaque progression among cocaine users with HIV and subclinical coronary atherosclerosis.
METHODS
Between March 2014 and August 2017, 76 cocaine users with HIV and coronary plaques were enrolled in a study designed to decrease cocaine use and determine whether doing so impacted progression of subclinical coronary atherosclerosis as measured by coronary artery computed tomography examinations. Of the 76, 7 did not complete the study, resulting in 69 participants. A 12-month cash-based CM intervention was implemented to promote cocaine abstinence or reduced cocaine use. Generalized estimating equation approach was used to perform longitudinal data analyses.
FINDINGS
During the 12-month CM, all 69 participants reduced cocaine use, and of these, 25 (36%; 95% confidence interval, 25%-49%) achieved cocaine abstinence. After adjusting for potential confounding factors, generalized estimating equation analyses showed that (1) endothelin-1 (ET-1) levels, a proinflammatory biomarker for endothelial dysfunction, at the 6-month and 12-month visits were significantly lower compared with baseline ET-1 ( P = 0.001 and P < 0.001, respectively), and (2) low-attenuation noncalcified coronary plaque volume, a predictor for myocardial infarction, at 12-month visit was significantly lower compared with baseline low-attenuation noncalcified coronary plaque volume ( P < 0.05).
CONCLUSIONS
The findings of this study have not only demonstrated that CM is effective in achieving a sustained reduction in cocaine use, but also provided compelling evidence that reduction in cocaine use leads to quantifiable cardiovascular health benefits, including concurrent decrease in high-risk plaque burden and ET-1, among cocaine users with HIV-associated coronary atherosclerosis.
背景
使用可卡因会加剧人类免疫缺陷病毒（HIV）相关的亚临床冠状动脉粥样硬化。我们调查了通过应急管理（CM）干预实现的可卡因戒断或减少使用是否会延缓患有HIV和亚临床冠状动脉粥样硬化的可卡因使用者中高危冠状动脉斑块的进展。
方法
在2014年3月至2017年8月期间，76名患有HIV和冠状动脉斑块的可卡因使用者参加了一项旨在减少可卡因使用并确定这样做是否会影响通过冠状动脉计算机断层扫描检查测量的亚临床冠状动脉粥样硬化进展的研究。在这76名参与者中，7人未完成研究，最终有69名参与者。实施了为期12个月的基于现金的CM干预，以促进可卡因戒断或减少可卡因使用。采用广义估计方程方法进行纵向数据分析。
结果
在为期12个月的CM期间，所有69名参与者都减少了可卡因使用，其中25人（36%；95%置信区间，25%-49%）实现了可卡因戒断。在调整潜在混杂因素后，广义估计方程分析表明：（1）作为内皮功能障碍促炎生物标志物的内皮素-1（ET-1）水平，在6个月和12个月随访时与基线ET-1相比显著降低（分别为P = 0.001和P < 0.001）；（2）作为心肌梗死预测指标的低衰减非钙化冠状动脉斑块体积，在12个月随访时与基线低衰减非钙化冠状动脉斑块体积相比显著降低（P < 0.05）。
结论
本研究结果不仅表明CM在持续减少可卡因使用方面有效，还提供了令人信服的证据，即减少可卡因使用会给心血管健康带来可量化的益处，包括在患有HIV相关冠状动脉粥样硬化的可卡因使用者中同时降低高危斑块负担和ET-1水平。
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