9th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 19-21 July 2007, Sydney, Australia

DOES DIABETES MELLITUS (DM) CONFER AN EQUIVALENT RISK OF CORONARY HEART DISEASE (CHD) TO PRE-EXISTING CHD IN HIV-POSITIVE INDIVIDUALS?

Antiviral Therapy 2007; 12(Suppl. 2):L10 (abstract no. O-09)

SW Worm¹, S De Wit², R Weber³, CA Sabin⁴, P Reiss⁵, W El-Sadr⁶, A D‘Arminio Monforte⁷, O Kirk⁸, E Fontas⁹, F Dabis¹⁰, MG Law¹¹, JD Lundgren¹ and N Friis-Møller¹ on behalf of the D:A:D study group
¹Copenhagen HIV Programme (CHIP), Hvidovre University Hospital, Copenhagen, Denmark; ²Saint-Pierre Cohort, CHU Saint-Pierre Hospital, Brussels, Belgium; ³SHCS, Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland; ⁴Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College, London, UK; ⁵ATHENA, HIV Monitoring Foundation, Academic Medical Center, Amsterdam, The Netherlands; ⁶CPCPRA Columbia University/Harlem Hospital, New York, NY, USA; ⁷ICONA, L Sacco Hospital, University of Milan, Milan, Italy; ⁸EuroSIDA, CHIP, Hvidovre University Hospital, Copenhagen, Denmark; ⁹Nice Cohort, CHU Nice Hopital de l’Archet, Nice, France; ¹⁰INSERM E0338 & U593, ISPED, Université Victor Segalen Bordeaux 2, Bordeaux, France; ¹¹AHOD, National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia

BACKGROUND: NCEP guidelines operate with a concept of ‘CHD risk equivalent’ a disease state conferring similar risk of CHD as pre-existing CHD. In HIV, risk factors for diabetes mellitus (DM) may differ from those in the background population (e.g. ART-induced). It is unknown if DM should be considered a CHD risk equivalent in HIV.

METHODS: The incidence of a composite CHD outcome (myocardial infarction, angioplasty, bypass or fatal cardiovascular event) was calculated according to the presence (+) or absence (-) of prior CHD and ± DM at D:A:D baseline. Multivariable Poisson analyses compared the risk of CHD in these four groups after adjustment for gender, age, cohort, HIV transmission, ethnicity, family history of CHD, smoking and calendar year. Sensitivity analysis assessed the risk of CHD according to duration of DM: no DM, DM during follow-up of <2 years, DM during follow-up of >2 years and DM before baseline.

RESULTS: The incidence rate for CHD per 100 PY in persons with -DM and -CHD, +DM and -CHD, +CHD and -DM, and +DM and +CHD were 0.32 (95%CI 0.29–0.35), 1.40 (1.02–1.71), 7.73 (6.03–9.42), and 8.48 (5.11–13.25), respectively. Using a prior CHD (+CHD, -DM) as a reference group, the relative rate (RR) of CHD associated with DM (+DM, -CHD) was 0.30 (Table 1). There was a trend towards increasing risk of CHD with longer duration of DM (Table 2).

DISCUSSION: A history of CHD is a far stronger predictor of CHD than a diagnosis of DM in HIV. Prior CHD was a strong predictor of recurrence of CHD, regardless of whether the patient also had DM or not. Conversely, in patients without prior CHD, DM was an important risk factor for CHD, but not a CHD risk equivalent. A higher risk of CHD was observed with longer time since diagnosis of DM. Intensity of preventive interventions should be guided by estimates of absolute CHD risk from the Framingham equation or the D:A:D risk equation currently under development.

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2007-07-24
O-09

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