Objectives: To evaluate the cardiovascular risk factors associated with sub-clinical carotid atherosclerosis in antiretroviral-therapy-naı¨ve HIVinfected patients. Methods: HERMES study enrolled consecutive ART-therapy-naı¨ve patients. It was designed to identify metabolic-syndrome (MS) and cardiovascular risk factors. The present analysis is a nested crosssectional study with a subset of patients examined by carotidultrasonography. Their ten-year probability of cardiovascular events was calculated using the Framingham Risk Score (FRS) and three other cardiovascular-algorithms (the Global Framingham Risk Score- GFRS, ’’Progetto-Cuore’’, and ’’SCORE’’). Vascular age was estimated using a new model derived from GFRS and was compared with chronological age. The diagnosis of MS was based on NCEP and IDF definitions. Sub-clinical atherosclerosis was determined as ultrasound carotid intima-media thickness (IMT) >0.9 mm. Results: Out of 140 patients enrolled in the HERMES study by the four centers participating to the nested study, a total of 72 (51.4%) subjects, with no overt cardiovascular disease, were examined by carotid-ultrasonography. The median age 40 years, 79.2% males. The vascular age was 7.6 years higher than chronological age. The factors associated with subclinical atherosclerosis were age (p< 0.0001), vascular age (p=0.0002), BMI (p=0.003), waist circumference (p=0.0002), MS (IDF definition, p=0.004) and all the CV models (FRS, p=0.01, GFRS, p=0.002, Progetto-Cuore, p=0.018, SCORE, p=0.03). Independently from other significant factors, waist circumference was significantly associated with pathological results (p=0.007). The GFRS (area under the receiver operating characteristic curves, 0.78; p< 0.001) had slightly better predictive accuracy than the other three CV-models (FRS, AUC=0.71, p=0.003; Progetto-Cuore, AUC=0.74, p=0.0005; SCORE, AUC=0.77, p< 0.0001); 55% of patients at intermediate risk (6–20%) had sub-clinical carotid lesions. Conclusions: Sub-clinical carotid lesions had a highly significant direct association with all the CV-risk predictors. The GFRS and vascular age were highly predictive. We recommend an ultrasonographic examination among HIV patients with GFRS ‡6% or with an elevated waist circumference.
Relations between cardiovascular risk estimates and subclinical atherosclerosis in naı¨ve HIV patients: results from the HERMES study
De Socio G;
2009
Abstract
Objectives: To evaluate the cardiovascular risk factors associated with sub-clinical carotid atherosclerosis in antiretroviral-therapy-naı¨ve HIVinfected patients. Methods: HERMES study enrolled consecutive ART-therapy-naı¨ve patients. It was designed to identify metabolic-syndrome (MS) and cardiovascular risk factors. The present analysis is a nested crosssectional study with a subset of patients examined by carotidultrasonography. Their ten-year probability of cardiovascular events was calculated using the Framingham Risk Score (FRS) and three other cardiovascular-algorithms (the Global Framingham Risk Score- GFRS, ’’Progetto-Cuore’’, and ’’SCORE’’). Vascular age was estimated using a new model derived from GFRS and was compared with chronological age. The diagnosis of MS was based on NCEP and IDF definitions. Sub-clinical atherosclerosis was determined as ultrasound carotid intima-media thickness (IMT) >0.9 mm. Results: Out of 140 patients enrolled in the HERMES study by the four centers participating to the nested study, a total of 72 (51.4%) subjects, with no overt cardiovascular disease, were examined by carotid-ultrasonography. The median age 40 years, 79.2% males. The vascular age was 7.6 years higher than chronological age. The factors associated with subclinical atherosclerosis were age (p< 0.0001), vascular age (p=0.0002), BMI (p=0.003), waist circumference (p=0.0002), MS (IDF definition, p=0.004) and all the CV models (FRS, p=0.01, GFRS, p=0.002, Progetto-Cuore, p=0.018, SCORE, p=0.03). Independently from other significant factors, waist circumference was significantly associated with pathological results (p=0.007). The GFRS (area under the receiver operating characteristic curves, 0.78; p< 0.001) had slightly better predictive accuracy than the other three CV-models (FRS, AUC=0.71, p=0.003; Progetto-Cuore, AUC=0.74, p=0.0005; SCORE, AUC=0.77, p< 0.0001); 55% of patients at intermediate risk (6–20%) had sub-clinical carotid lesions. Conclusions: Sub-clinical carotid lesions had a highly significant direct association with all the CV-risk predictors. The GFRS and vascular age were highly predictive. We recommend an ultrasonographic examination among HIV patients with GFRS ‡6% or with an elevated waist circumference.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
