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Factors Associated with a High Cardiovascular Risk in HIV-infected Patients in Spain: A Multicenter, Nationwide, Cross-sectional Study
E Martinez*1, J Arribas2, J López-Aldeguer3, F Gutierrez4, C Miralles5, F Lozano6, M del Pozo7, J Santamaria8, E Ribera9, B de la Fuente10, P Viciana11, C Gerco12, I Suarez13, M Rodriguez14, A Rivero15, and on behalf of the RiCVih Study Group
1Hosp Clin, Barcelona, Spain; 2Hosp La Paz, Madrid, Spain; 3Hosp La Fe, Valencia, Spain; 4Hosp Univ Elche, Alicante, Spain; 5Hosp Xeral, Vigo, Pontevedra, Spain; 6Hosp Univ de Valme, Seville, Spain; 7Hosp Clin, Valladolid, Spain; 8Hosp Basurto, Bilbao, Spain; 9Hosp Vall d'Hebron, Barcelona, Spain; 10Hosp de Cabueñes, Asturias, Spain; 11Hosp Virgen del Rocio, Seville, Spain; 12Hosp del Mar, Barcelona, Spain; 13Hosp Infanta Elena, Huelva, Spain; 14Hosp Valle Nalon, Asturias, Spain; and 15Hosp Reina Sofia, Cordoba, Spain
Background:
HIV-infected patients receiving ART have an
increased risk for cardiovascular disease. We assessed the nationwide
prevalence and the
factors associated with a high cardiovascular risk in HIV-infected patients in Spain.
Methods: During the last week of June 2004, every
clinically stable HIV-infected adult with a regular visit to any of 126
hospitals distributed throughout Spain was invited to participate.
We collected data on demographics, age, gender, HIV infection, ART, and other
concurrently used drugs. Patients were asked for family history of premature cardiovascular disease, tobacco
smoking, and prior diagnosis of hypertension, dyslipidemia,
or diabetes mellitus. Weight, height, blood pressure, and waist circumference
were measured, and clinically evident body fat changes were assessed.
Laboratory results including fasting glucose, triglycerides, total-, LDL-, and
HDL-cholesterol were recorded. Cardiovascular risk was assessed through Framingham estimates, and
polytomous logistic regression was used to identify
factors associated with a cardiovascular risk >10 at 10 years.
Results: There were 3265 patients with valid data for
the analysis: 74% male, 64% smokers, 11%
with family history of premature cardiovascular disease, 7% hypertension, 5%
diabetes mellitus, 5% body mass index ≥ 30 kg/m2, 5% glucose
> 126 mg/dL, 28% triglycerides > 200 mg/dL, 13% total cholesterol > 240 mg/dL,
4% metabolic syndrome; and 91 (3%) patients had suffered an ischemic event. Framingham score (median,
IQR) in men was 9 (6 to 12) and in women 9 (6 to 14). In all, 1347 (41%)
patients had an estimated risk > 10 at 10 years. Multivariate analysis
identified the following factors as independently associated with the risk of
having an estimated risk > 10 (considering < 5 as a reference): female gender (compared with male) 0.01 (< 0.01
to 0.24), age (per year) 1.49 (1.40 to 1.59), age in men (compared with age in
women, per year) 1.31 (1.23 to 1.40), total cholesterol 200 to 240 mg/dL (compared with < 200) 138.32 (81.41 to 235.04), total
cholesterol > 240 mg/dL (compared with < 200)
2013.54 (947.39 to 4279.48), smoker 4026.68 (1731.88 to 9362.17), hypertension
2.70 (1.35 to 5.37), triglycerides 200 to 250 mg/dL
(compared with < 200) 4.30 (2.90 to 6.41), triglycerides > 250 mg/dL (compared with < 200) 16.40 (5.83 to 46.14), and
lipid-lowering therapy 0.22 (0.10 to 0.47).
Conclusions: Tobacco smoking, and high plasma levels of
total cholesterol and triglycerides were identified as the factors more heavily
associated with a high cardiovascular risk in HIV-infected patients in Spain.
Keywords: risk factors; cardiovascular; epidemiology
