of Cardiovascular Risk in HIV Positive Individuals in Europe ||
|M. Shahmanesh1, A. Schultz1, F. Burns1, O. Kirk2, J. Lundgren3, C. Mussini4, C. Pedersen5, S. De Wit6, G. Kutsyna7, A. Mocroft1, on behalf of Eurosida in EuroCOORD|
|1University College London, Research Department of Infection and Population Health, London, United Kingdom, 2University of Copenhagen, Copenhagen HIV Programme, Copenhagen, Denmark, 3Rigshospitalet, Department of Infectious Diseases, Copenhagen, Denmark, 4Universita Modena, Modena, Italy, 5Odense University Hospital, Odense, Denmark, 6Saint-Pierre University Hospital, Department of Infectious Diseases, Brussels, Belgium, 7Luhansk AIDS Center, Luhansk, Ukraine|
|Objectives: HIV has become a long-term
condition associated with comorbidities of ageing, e.g. cardiovascular (CV)
disease. To inform health service
planning we investigate CV risk and factors associated with CV risk
modification in a European HIV-Cohort. |
(from 1/1/2000) with ≥2 time points for whom CV risk could be calculated using
the D:A:D risk equation were included in the analysis. Baseline was the first
date CV risk could be calculated. High risk was defined as a 5-year CV risk
>5%. Risk modification was defined as two consecutive measurements meeting
the European AIDs Clinical Society (EACS) guidelines (Table 1).
|Modifiable CV risk factors||Clinical indication for treatment of modifiable risk (based on EACS guidelines)||Successful risk modification
(Two consecutive measures)|
(systolic blood pressure (BP) >140 mm Hg, diastolic BP >90 mm Hg or on anti-hypertensive treatment)||Treatment of BP (systolic BP >140 or diastolic BP >90 mm Hg)||Systolic BP <140 (130 if diabetic), diastolic BP <90 (<80 if diabetic) mm Hg|
(total cholesterol>6 mmol/l, cholesterol:hdl cholesterol ratio >5 or receiving statins)||Predicted 10 year CV risk of over 20%, diabetic, or established CV disease||Lowering total cholesterol to less than 4 mmol/l|
|Current smoker||Current smoker||Stopped smoking|
(Body Mass Index (BMI) over 25 kg/m2)|| ||Lowering BMI to less than 25 kg/m2 (as a measure of lifestyle changes)|
[Table 1: Definitions of modifiable CV risk factors]
Factors associated with risk
development and modifications were investigated using Poisson regression.
Individuals were followed from baseline until the outcome of interest, the
month of their last modifiable risk factor measurement, or 31/12/2011,
whichever occurred first.
Of 5719 individuals, 31.4%
were hypertensive, 47.4% had high cholesterol levels, and 47.8% were current
smokers. 1140 (19.9%) had a 5-year CV risk of > 5%. Of 4142 individuals with
a baseline 5-year risk < 5%, 1157 (27.6%) developed high CV risk during
follow-up, (6.6/100 person years of follow-up, 95% confidence interval [CI] 6.3-6.9).
They were more likely to be male (adjusted rate ratio [aRR]=3.81, CI=3.21-4.53)
and older (aRR=3.43, CI=3.12-3.63 per 10
Of those clinically indicated for risk
modification, 819/1533 (45.6%) successfully modified BP; 803/2709 (29.6%)
stopped smoking; 172/910 (18.9%) modified cholesterol and 418/1663 (25.1%) reduced
their BMI. Factors found to be associated with risk modification are shown in Figure 1
. Risk modification for BP and
smoking improved over time (p< 0.001).
The prevalence and incidence of CV risk was high. More than half modified
some aspect of their CV risk and this seems to have improved over time. There were
geographical and gender heterogeneities which warrant further investigation.
[Figure 1: AdjRate Ratios for Risk Modification]
Maryam Shahmanesh , University College London , London , United Kingdom
Assigned in sessions:
17.10.2013, 12:00-14:00, Poster Session, Poster Session 1, Exhibition
18.10.2013, 12:00-14:00, Poster Session, Poster Session 2, Exhibition