Nweke Martins, Ibeneme Sam, Pillay Julian D, Mshunqane Nombeko
Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Global Health and Sustainability, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa.
Front Cardiovasc Med. 2025 Aug 12;12:1586019. doi: 10.3389/fcvm.2025.1586019. eCollection 2025.
Coronary artery disease (CAD) is a leading cause of mortality among people living with HIV (PLWH). Risk stratification remains inconsistent due to geographic disparities, ART-related metabolic effects, and overreliance on strength of association. This review synthesizes global evidence to classify CAD risk factors in PLWH, aiming to improve predictive models and preventative strategies.
Following the PRISMA 2020 guidelines, a systematic review was conducted across six databases: PubMed, Scopus, Web of Science, Medline, CINAHL, and African Journals (SABINET). Two independent reviewers screened studies and extracted data. Narrative synthesis and meta-analysis were conducted. Risk factors were classified using Rw, causality index (CI), and public health priority (PHP).
Twenty-two studies involving 103,370 participants were included. First-class risk factors (CI: 7-10) included hypertension (OR: 4.9; < 0.05; Rw: 4.5), advanced age (≥50 years) (OR: 4.96, < 0.05, Rw: 3.58), dyslipidemia (OR: 2.15, < 0.04, Rw: 2.15), and overweight/obesity (OR: 1.81, < 0.05, Rw: 1.36). Second-class risk factors (CI: 5-6) included family history of CVD (OR: 3.25, < 0.05; Rw: 2. 24). Third-class risk factors (CI ≤4) included diabetes (OR: 2.64, < 0.05, Rw: 1.32), antiretroviral therapy exposure (OR: 1.68, < 0.05, Rw: 0.63), and homosexuality (OR: 1.82, < 0.05, Rw: 0.62). Critical thresholds (cumulative Rw: 14.8 and 8.0) were set at 75th and 50th percentiles of cumulative Rw. At GTT value of 0.50, the parsimonious global clinical prediction model for HIV-related CAD included age, hypertension, dyslipidemia, family history of CVD, diabetes, and overweight/obesity (Rw: 15.5, GTT: 4.05). For primary prevention, the optimal model comprised hypertension, dyslipidemia, and obesity (Rw: 8.01, GTT: 2.07). Advanced age and hypertension were "necessary causes" of CAD among PLWH.
Association strength alone cannot determine CAD risk. Cumulative risk indexing and responsiveness provide a robust framework. Prevention should prioritize hypertension and dyslipidemia management, with interventions for obesity, smoking, and virological failure. Age and hypertension should prompt cardiovascular screening. Standardized risk definitions, accounting for the role of protective factors and integrating evidence with domain knowledge are vital for improved CAD risk stratification and prediction in PLWH. Routine cardiovascular screening in HIV care remains essential.
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524494, PROSPERO CRD42024524494.
冠状动脉疾病（CAD）是人类免疫缺陷病毒感染者（PLWH）死亡的主要原因。由于地理差异、抗逆转录病毒治疗（ART）相关的代谢影响以及对关联强度的过度依赖，风险分层仍然不一致。本综述综合全球证据对PLWH中的CAD危险因素进行分类，旨在改进预测模型和预防策略。
遵循PRISMA 2020指南，对六个数据库进行了系统综述：PubMed、Scopus、Web of Science、Medline、CINAHL和非洲期刊（SABINET）。两名独立评审员筛选研究并提取数据。进行了叙述性综合分析和荟萃分析。使用相对权重（Rw）、因果指数（CI）和公共卫生优先事项（PHP）对危险因素进行分类。
纳入了22项涉及103370名参与者的研究。一级危险因素（CI：7 - 10）包括高血压（OR：4.9；P < 0.05；Rw：4.5）、高龄（≥50岁）（OR：4.96，P < 0.05，Rw：3.58）、血脂异常（OR：2.15，P < 0.04，Rw：2.15）和超重/肥胖（OR：1.81，P < 0.05，Rw：1.36）。二级危险因素（CI：5 - 6）包括心血管疾病家族史（OR：3.25，P < 0.05；Rw：2.24）。三级危险因素（CI≤4）包括糖尿病（OR：2.64，P < 0.05，Rw：1.32）、抗逆转录病毒治疗暴露（OR：1.68，P < 0.05，Rw：0.63）和同性恋（OR：1.82，P < 0.05，Rw：0.62）。临界阈值（累积Rw：14.8和8.0）设定为累积Rw的第75和第50百分位数。在GTT值为0.50时，用于HIV相关CAD的简约全球临床预测模型包括年龄、高血压、血脂异常、心血管疾病家族史、糖尿病和超重/肥胖（Rw：15.5，GTT：4.05）。对于一级预防，最佳模型包括高血压、血脂异常和肥胖（Rw：8.01，GTT：2.07）。高龄和高血压是PLWH中CAD的“必要病因”。
仅凭关联强度不能确定CAD风险。累积风险指数和反应性提供了一个强大的框架。预防应优先管理高血压和血脂异常，并对肥胖、吸烟和病毒学失败进行干预。年龄和高血压应促使进行心血管筛查。标准化的风险定义，考虑保护因素的作用并将证据与领域知识相结合，对于改善PLWH中CAD的风险分层和预测至关重要。HIV护理中的常规心血管筛查仍然至关重要。
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024524494，PROSPERO CRD42024524494。
