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01-03-2013 | Original Paper

Prevalence of cardiovascular diseases in HIV-infected outpatients: results from a prospective, multicenter cohort study

Authors: Stefan Esser, Götz Gelbrich, Norbert Brockmeyer, Alexander Goehler, Dirk Schadendorf, Raimund Erbel, Till Neumann, Nico Reinsch

Published in: Clinical Research in Cardiology | Issue 3/2013

Abstract

Background

Recent studies suggest a rising rate of cardiovascular disease (CVD) in HIV-infected subjects. Although most countries have an aging HIV-infected population, there remains a lack of knowledge about associated cardiovascular diseases.

Methods

This ongoing prospective multicentre observational cohort study aims to elucidate CVD prevalence in HIV-infected outpatients by standardized non-invasive cardiovascular screening. Cardiovascular and coronary risk was calculated using Framingham risk scores.

Results

803 HIV-infected subjects (mean age 44.2 years, female 16.6 %) were included. The prevalence of CVD in HIV-infected subjects was 10.1 % (95 % CI 8.0–12.2 %). Aging HIV-infected patients (≥45 years, N = 348) exhibited significantly increased rates of CVD, including an elevated frequency of coronary artery disease (7.5 vs. 1.8 %, p < 0.001), myocardial infarction (6.0 vs. 1.8 %, p = 0.002) and peripheral arterial diseases (4.6 vs. 1.5 %, p < 0.017). Furthermore, aging patients exhibited a higher rate of chronic heart failure (5.2 vs. 1.5 %, p < 0.001), predominantly of ischemic etiology. In multivariate analyses, age (OR 2.05 per decade, 95 % CI 1.64–2.56), smoking (OR 5.96 per decade, 95 % CI 2.31–15.38) and advanced symptomatic HIV infection (OR 2.60 per decade, 95 % CI 1.31–5.15), were significantly associated with the prevalence of CVD. Based on the 10-year cardiovascular risk estimation, a disproportionate increase in cardiac events has to be expected in aging HIV-infected subjects in the next decades (≥45 years/<45 years 16.4 vs. 4.2 %, p < 0.001).

Conclusion

CVD in aging HIV-infected population is an increasing medical challenge. In the era of antiretroviral therapy, prevention and diagnostic strategies are essential to reduce the prevalence of CVD in HIV-infected patients.

Palella FJJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 338:853–860PubMedCrossRef

Chinello P, Petrosillo N (2007) QT interval prolongation and antiretroviral treatment: another point of interest. Clin Infect Dis 44:1388–1399 (author reply 1389–1391)PubMedCrossRef

Frerichs FC, Dingemans KP, Brinkman K (2002) Cardiomyopathy with mitochondrial damage associated with nucleoside reverse-transcriptase inhibitors. N Engl J Med 347:1895–1896PubMedCrossRef

Friis-Moller N, Sabin CA, Weber R, d’Arminio Monforte A, El-Sadr WM, Reiss P, Thiebaut R, Morfeldt L, De Wit S, Pradier C, Calvo G, Law MG, Kirk O, Phillips AN, Lundgren JD (2003) Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med 349:1993–2003PubMedCrossRef

Bijl M, Dieleman JP, Simoons M, van der Ende ME (2001) Low prevalence of cardiac abnormalities in an HIV-seropositive population on antiretroviral combination therapy [letter]. J Acquir Immune Defic Syndr 27(3):318–320PubMed

Sliwa K, Carrington MJ, Becker A, Thienemann F, Ntsekhe M, Stewart S (2012) Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort. Eur Heart J 33:866–874PubMedCrossRef

Jain RG, Furfine ES, Pedneault L, White AJ, Lenhard JM (2001) Metabolic complications associated with antiretroviral therapy. Antiviral Res 51:151–177PubMedCrossRef

Kan H, Xie Z, Finkel MS (2000) HIV gp120 enhances NO production by cardiac myocytes through p38 MAP kinase-mediated NF-kappaB activation. Am J Physiol Heart Circ Physiol. 279:H3138–H3143PubMed

Raidel SM, Haase C, Jansen NR, Russ RB, Sutliff RL, Velsor LW, Day BJ, Hoit BD, Samarel AM, Lewis W (2002) Targeted myocardial transgenic expression of HIV Tat causes cardiomyopathy and mitochondrial damage. Am J Physiol Heart Circ Physiol. 282:H1672–H1678PubMed

10.

Baker JV, Duprez D (2010) Biomarkers and HIV-associated cardiovascular disease. Curr Opin HIV AIDS. 5:511–516PubMedCrossRef

11.

Neumann T, Esser S, Potthoff A, Pankuweit S, Neumann A, Breuckmann F, Neuhaus K, Kondratieva J, Buck T, Muller-Tasch T, Wachter R, Prettin C, Gelbrich G, Herzog W, Pieske B, Rauchhaus M, Loffler M, Maisch B, Mugge A, Wasem J, Gerken G, Brockmeyer NH, Erbel R (2007) Prevalence and natural history of heart failure in outpatient HIV-infected subjects: rationale and design of the HIV-HEART study. Eur J Med Res. 12:243–248PubMed

12.

D’Agostino RBS, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB (2008) General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 117:743–753PubMedCrossRef

13.

Khunnawat C, Mukerji S, Havlichek DJ, Touma R, Abela GS (2008) Cardiovascular manifestations in human immunodeficiency virus-infected patients. Am J Cardiol 102:635–642PubMedCrossRef

14.

Ntsekhe M, Mayosi BM (2009) Cardiac manifestations of HIV infection: an African perspective. Nat Clin Pract Cardiovasc Med. 6:120–127PubMedCrossRef

15.

Currier JS, Lundgren JD, Carr A, Klein D, Sabin CA, Sax PE, Schouten JT, Smieja M (2008) Epidemiological evidence for cardiovascular disease in HIV-infected patients and relationship to highly active antiretroviral therapy. Circulation 118:e29–e35PubMedCrossRef

16.

Neumann T, Woiwod T, Neumann A, Miller M, Von Birgelen C, Volbracht L, Esser S, Brockmeyer N, Gerken G, Erbel R (2004) Cardiovascular risk factors and probability for cardiovascular events in HIV-infected patients—Part III: age differences. Eur J Med Res. 9:267–272PubMed

17.

Corral I, Quereda C, Moreno A, Perez-Elias MJ, Dronda F, Casado JL, Muriel A, Masjuan J, Alonso-de-Lecinana M, Moreno S (2009) Cerebrovascular ischemic events in HIV-1-infected patients receiving highly active antiretroviral therapy: incidence and risk factors. Cerebrovasc Dis. 27:559–563PubMedCrossRef

18.

Friis-Moller N, Reiss P, Sabin CA, Weber R, Monforte A, El-Sadr W, Thiebaut R, De Wit S, Kirk O, Fontas E, Law MG, Phillips A, Lundgren JD (2007) Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med 356:1723–1735PubMedCrossRef

19.

Obel N, Thomsen HF, Kronborg G, Larsen CS, Hildebrandt PR, Sorensen HT, Gerstoft J (2007) Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study. Clin Infect Dis 44:1625–1631PubMedCrossRef

20.

Sabin CA, Worm SW, Weber R, Reiss P, El-Sadr W, Dabis F, De Wit S, Law M, D’Arminio Monforte A, Friis-Moller N, Kirk O, Pradier C, Weller I, Phillips AN, Lundgren JD (2008) Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet 371:1417–1426PubMedCrossRef

21.

Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, Spooner KM, Armstrong AW, Fraser S, Wallace MR (2006) Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr 41:194–200PubMedCrossRef

22.

El-Sadr WM, Lundgren JD, Neaton JD, Gordin F, Abrams D, Arduino RC, Babiker A, Burman W, Clumeck N, Cohen CJ, Cohn D, Cooper D, Darbyshire J, Emery S, Fatkenheuer G, Gazzard B, Grund B, Hoy J, Klingman K, Losso M, Markowitz N, Neuhaus J, Phillips A, Rappoport C (2006) CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med 355:2283–2296PubMedCrossRef

23.

Antiretroviral Therapy Cohort Collaboration (2008) Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 372:293–299CrossRef

24.

Erbel R, Mohlenkamp S, Moebus S, Schmermund A, Lehmann N, Stang A, Dragano N, Gronemeyer D, Seibel R, Kalsch H, Brocker-Preuss M, Mann K, Siegrist J, Jockel KH (2010) Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol 56:1397–1406PubMedCrossRef

25.

Fischer D, Kindermann I, Karbach J, Herzberg PY, Ukena C, Barth C, Lenski M, Mahfoud F, Einsle F, Dannemann S, Bohm M, Kollner V (2012) Heart-focused anxiety in the general population. Clin Res Cardiol. 101:109–116PubMedCrossRef

26.

Laufs U, Hoppe UC, Rosenkranz S, Kirchhof P, Bohm M, Diener HC, Endres M, Grond M, Hacke W, Meinertz T, Ringelstein EB, Rother J, Dichgans M (2010) Cardiological evaluation after cerebral ischaemia : consensus statement of the Working Group Heart and Brain of the German Cardiac Society-Cardiovascular Research (DGK) and the German Stroke Society (DSG). Clin Res Cardiol. 99:609–625PubMedCrossRef

27.

Reinsch N, Neuhaus K, Esser S, Potthoff A, Hower M, Mostardt S, Neumann A, Brockmeyer NH, Gelbrich G, Erbel R, Neumann T (2012) Are HIV patients undertreated? Cardiovascular risk factors in HIV: results of the HIV-HEART study. Eur J Prev Cardiol. 19:267–274PubMedCrossRef

28.

Dube MP, Stein JH, Aberg JA, Fichtenbaum CJ, Gerber JG, Tashima KT, Henry WK, Currier JS, Sprecher D, Glesby MJ (2003) Guidelines for the evaluation and management of dyslipidemia in human immunodeficiency virus (HIV)-infected adults receiving antiretroviral therapy: recommendations of the HIV Medical Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group. Clin Infect Dis 37:613–627PubMedCrossRef

29.

Ho JE, Hsue PY (2009) Cardiovascular manifestations of HIV infection. Heart 95:1193–1202PubMedCrossRef

30.

Blanco F, San Roman J, Vispo E, Lopez M, Salto A, Abad V, Soriano V (2010) Management of metabolic complications and cardiovascular risk in HIV-infected patients. AIDS Rev 12:231–241PubMed

31.

Carr A, Samaras K, Burton S, Law M, Freund J, Chisholm DJ, Cooper DA (1998) A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS. 12:F51–F58PubMedCrossRef

32.

Iloeje UH, Yuan Y, L’italien G, Mauskopf J, Holmberg SD, Moorman AC, Wood KC, Moore RD (2005) Protease inhibitor exposure and increased risk of cardiovascular disease in HIV-infected patients. HIV Med. 6:37–44PubMedCrossRef

33.

Ho JE, Deeks SG, Hecht FM, Xie Y, Schnell A, Martin JN, Ganz P, Hsue PY (2010) Initiation of antiretroviral therapy at higher nadir CD4+ T-cell counts is associated with reduced arterial stiffness in HIV-infected individuals. AIDS. 24:1897–1905PubMedCrossRef

34.

Tebas P, Henry WK, Matining R, Weng-Cherng D, Schmitz J, Valdez H, Jahed N, Myers L, Powderly WG, Katzenstein D (2008) Metabolic and immune activation effects of treatment interruption in chronic HIV-1 infection: implications for cardiovascular risk. PLoS ONE 3:e2021PubMedCrossRef

35.

d’Arminio A, Sabin CA, Phillips AN, Reiss P, Weber R, Kirk O, El-Sadr W, De Wit S, Mateu S, Petoumenos K, Dabis F, Pradier C, Morfeldt L, Lundgren JD, Friis-Moller N (2004) Cardio- and cerebrovascular events in HIV-infected persons. AIDS. 18:1811–1817PubMedCrossRef

36.

Friis-Moller N, Thiebaut R, Reiss P, Weber R, Monforte AD, De Wit S, El-Sadr W, Fontas E, Worm S, Kirk O, Phillips A, Sabin CA, Lundgren JD, Law MG (2010) Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study. Eur J Cardiovasc Prev Rehabil. 17:491–501PubMedCrossRef

37.

Hsue PY, Waters DD (2005) What a cardiologist needs to know about patients with human immunodeficiency virus infection. Circulation 112:3947–3957PubMedCrossRef

38.

Lewis W, Miller YK, Haase CP, Ludaway T, McNaught J, Russ R, Steltzer J, Folpe A, Long R, Oshinski J (2005) HIV viral protein R causes atrial cardiomyocyte mitosis, mesenchymal tumor, dysrhythmia, and heart failure. Lab Invest 85:182–192PubMedCrossRef

39.

Reinsch N, Neuhaus K, Esser S, Potthoff A, Hower M, Brockmeyer NH, Erbel R, Neumann T (2010) Prevalence of cardiac diastolic dysfunction in HIV-infected patients: results of the HIV-HEART study. HIV Clin Trials. 11:156–162PubMedCrossRef

40.

Breuckmann F, Neumann T, Kondratieva J, Wieneke H, Ross B, Nassenstein K, Barkhausen J, Kreuter A, Brockmeyer N, Erbel R (2005) Dilated cardiomyopathy in two adult human immunodeficiency positive (HIV +) patients possibly related to highly active antiretroviral therapy (HAART). Eur J Med Res. 10:395–399PubMed

41.

D’Agostino RBS (2012) Cardiovascular risk estimation in 2012: lessons learned and applicability to the HIV population. J Infect Dis 205(Suppl 3):S362–S367PubMedCrossRef

42.

del Rio C (2008) Updated antiretroviral treatment guidelines from DHHS and EACS. 20(1) (Sect. 7)

Title: Prevalence of cardiovascular diseases in HIV-infected outpatients: results from a prospective, multicenter cohort study
Authors: Stefan Esser
Götz Gelbrich
Norbert Brockmeyer
Alexander Goehler
Dirk Schadendorf
Raimund Erbel
Till Neumann
Nico Reinsch
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Clinical Research in Cardiology / Issue 3/2013
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-012-0519-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prevalence of cardiovascular diseases in HIV-infected outpatients: results from a prospective, multicenter cohort study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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