Abstract PE15/18
Management of Cardiovascular Risk in HIV Positive Individuals in Europe Print
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.
Methods: EuroSIDA patients (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 factorsClinical indication for treatment of modifiable risk (based on EACS guidelines)Successful risk modification (Two consecutive measures)
Hypertension (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
High cholesterol (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 diseaseLowering total cholesterol to less than 4 mmol/l
Current smokerCurrent smokerStopped smoking
Overweight (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.
Results: 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 year increase).
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).
Conclusion: 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]

Assigned speakers:
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