815
Presence of the Metabolic Syndrome Is Not a Better Predictor of Cardiovascular Disease than the Sum of its Components: Data from the D:A:D Study
Signe W Worm*1, C Sabin2, P Reiss3, W El-Sadr4, A D'Arminio Monforte5, M Law6, M Rickenback7, S De Wit8, J Lundgren1, N Friis-Moller1, and The D:A:D Study Group
1Copenhagen HIV Prgm, Hvidovre, Denmark; 2Royal Free Ctr for HIV Med, Royal Free and Univ Coll London, UK; 3ATHENA, HIV Monitoring Fndn, Academic Med Ctr, Amsterdam, The Netherlands; 4CPCPRA, Columbia Univ and Harlem Hosp, New York, NY, US; 5ICONA, Hosp San Paolo, Univ of Milan, Italy; 6Australian HIV Observational Database, Natl Ctr in HIV Epidemiology and Clin Res, Sydney; 7Swiss HIV Corhort Study, Univ Hosp Lausanne; and 8Ctr Hosp Univ St Pierre, Brussels, Belgium
Background: The metabolic syndrome is a
cluster of cardiovascular disease (CVD) risk factors thought to be associated
with a 2-fold increased risk of CVD in the general population. It is much
debated whether the metabolic syndrome (defined
as ≥3 risk factors) contributes additional information over and
above that provided by the individual risk factors alone. In a population of
HIV infected persons, we investigated whether combinations of risk factors lead
to a higher than expected CVD risk.
Methods: Prospective multi-national cohort study of 23,236 HIV-infected subjects.
The effect of combinations of components of the metabolic syndrome for the risk
of a composite CVD endpoint (myocardial infarction, stroke, and invasive
procedures) was assessed by Poisson regression by incorporating interactions
between each pair of risk factors (adjusting for age, sex, family history of
CVD, smoking status, calendar year, and exposure to cART).
We considered triglycerides ≥1.7mmol/L, HDL cholesterol ≤1.0 mmol/L in men, ≤1.3 mmol/L
in women (HDL), systolic blood pressure >130 or diastolic blood pressure
>85 mmHg, body mass index >25 kg/m2, and a diagnosis of
diabetes mellitus. The results were validated in a dataset of n = 10,143 individuals.
Results: An increased CVD risk was found
with increasing number of concomitant risk factors (unadjusted relative rate
per additional factor: 1.70, 95%CI 1.50 to 1.93). When exploring pairwise combinations, the highest CVD rates (per 100
persons years) were seen in patients with high blood pressure and body mass
index (3.27 vs 0.46 in patients with no high blood
pressure and normal body mass index, diabetes mellitus, and decreased HDL (3.26
vs 0.54 in patients with no diabetes mellitus and
normal HDL), high blood pressure and elevated triglycerides (3.01 vs 0.34 in patients without high blood pressure and with
normal triglycerides) and diabetes mellitus and elevated triglycerides (2.47 vs 0.37 in patients with normal triglycerides and no diabetes
mellitus. There were no positive interactions between the pairwise
combinations of risk factors. After adjusting for each of the individual risk
factors as well as other confounders, there was no independent association with
having metabolic syndrome (1.03, 95%CI 0.63 to 1.68).
Conclusions: There is a strong
correlation between the number of the components of the metabolic syndrome observed
together in individual patients and CVD risk. However, when seen together, the
combined effect of these factors for the risk of CVD is comparable to that expected
by multiplying their individual effects. Thus, presence of metabolic syndrome in
HIV appears not to increase the CVD risk over and above that conferred by the
components of the syndrome separately.
|
