Liu Min, Li Mei, Liu Qian, Fu Yongjia, Wu Yushan, Huang Rui, Cao Qi, Yang Honghong
Division of Infectious Diseases, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, China.
AIDS Res Ther. 2024 Dec 19;21(1):92. doi: 10.1186/s12981-024-00684-7.
Atherosclerotic cardiovascular disease (ASCVD) has become an increasingly common cause of death among people living with HIV (PLHIV) receiving successful antiretroviral therapy (ART). In Chongqing, approximately half of the PLHIV were middle-aged or elderly, and their diets were mainly high in salt, spices and oil; however, there is still a lack of relevant research on the risk factors and whether the disease burden of ASCVD is greater in these areas. This study was to investigate the risk of ASCVD in middle-aged and elderly PLHIV receiving ART and analyze the factors influencing high risk.
A cross-sectional study was conducted at Chongqing Public Health Medical Center. Questionnaire surveys, physical examinations and laboratory examinations were used to collect information from PLHIV aged ≥ 45 years. Pooled cohort equations (PCEs) were used to calculate the 10-year ASCVD risk and analyze the influencing factors. The 10-year ASCVD risk score was used to define patients in the low-risk subgroup (< 7.5%) and high-risk subgroup (≥ 7.5%), and the risk factors were compared between the two groups.
In total, 463 PLHIV (median age 55.0 years, male 68.5%) were included, and the median duration of ART was 45.0 (15.0, 70.3) months. Of the 463 PLHIV, 13 (2.8%) had a known history of ASCVD. In the present study, 153 PLHIV (33.0%) were classified into the high-risk group, and 310 PLHIV (67.0%) were classified into the low-risk group. Compared with the low-risk group, the high-risk group was more likely to be female, older age, live in urban areas, be unemployed, have poor sleep quality, have higher low-density lipoprotein cholesterol (LDL-c), have higher total cholesterol (TC), and have diabetes and hypertension; however, coffee consumption was associated with a low risk of ASCVD. In addition, there were no differences in HIV viral load, CD4 + T-cell count, or duration on ART, or ART regimes between the two groups. According to multiple logistic regression, older age [odds ratio (OR) = 62.469, 95% CI 27.456, 142.134], female sex [OR = 9.635, 95% CI 4.384, 21.179], higher LDL-c levels [OR = 1.018, 95% CI 1.000, 1.036], accompanied hypertension [OR = 8.642, 95% CI 3.373, 22.143] and diabetes [OR = 10.806, 95% CI 3.787, 30.834] were found to be independent risk factors for the 10-year risk of ASCVD.
The overall 10-year ASCVD risk is great for middle-aged and elderly PLHIV in Chongqing, China. The risk factors for the 10-year risk of ASCVD were older age, female sex, elevated LDL-c level, and coexisting hypertension and diabetes.
在接受成功抗逆转录病毒治疗（ART）的人类免疫缺陷病毒感染者（PLHIV）中，动脉粥样硬化性心血管疾病（ASCVD）已成为日益常见的死亡原因。在重庆，约一半的PLHIV为中年或老年人，他们的饮食主要高盐、多香料和多油；然而，在这些地区，关于ASCVD的危险因素以及疾病负担是否更大仍缺乏相关研究。本研究旨在调查接受ART的中年和老年PLHIV发生ASCVD的风险，并分析影响高危的因素。
在重庆公共卫生医疗中心进行一项横断面研究。采用问卷调查、体格检查和实验室检查收集年龄≥45岁的PLHIV的信息。使用合并队列方程（PCEs）计算10年ASCVD风险并分析影响因素。使用10年ASCVD风险评分定义低风险亚组（<7.5%）和高风险亚组（≥7.5%）的患者，并比较两组之间的危险因素。
共纳入463例PLHIV（中位年龄55.0岁，男性占68.5%），ART的中位疗程为45.0（15.0，70.3）个月。在这463例PLHIV中，13例（2.8%）有ASCVD病史。在本研究中，153例PLHIV（33.0%）被分类为高风险组，310例PLHIV（67.0%）被分类为低风险组。与低风险组相比，高风险组更可能为女性、年龄较大、居住在城市地区、失业、睡眠质量差、低密度脂蛋白胆固醇（LDL-c）较高、总胆固醇（TC）较高，且患有糖尿病和高血压；然而，喝咖啡与ASCVD低风险相关。此外，两组之间的HIV病毒载量、CD4+T细胞计数、ART疗程或ART方案无差异。根据多因素logistic回归分析，年龄较大[比值比（OR）=62.469，95%置信区间（CI）27.456，142.134]、女性[OR=9.635，95%CI 4.384，21.179]、较高的LDL-c水平[OR=1.018，95%CI 1.000，1.036]、伴有高血压[OR=8.642，95%CI 3.373，22.143]和糖尿病[OR=10.806，95%CI 3.787，30.834]被发现是10年ASCVD风险的独立危险因素。
在中国重庆，中年和老年PLHIV的总体10年ASCVD风险较高。10年ASCVD风险的危险因素为年龄较大、女性、LDL-c水平升高以及并存高血压和糖尿病。
