Abstract
Objective
To assess the incidence, clinical features, treatment, and follow-up of coronary events in HIV-infected patients over a period of 5 years.
Patients and participants
A cohort of 840 patients.
Measurements and results
A coronary event occurred in 17 patients (5.9/1000 persons-years). Sixteen of them were exposed to highly active antiretroviral therapy (HAART). Patients with coronary events differed in age (48.3 vs. 43 years), CD4 T-cell count (284 vs. 486/mm3), total cholesterol (6.2 vs. 5.3 mmol/l), HDL cholesterol (0.72 vs. 1.16 mmol/l), and LDL cholesterol (4.95 vs. 3.391.61 mmol/l). No difference was observed regarding duration of HAART, weight, glucose level, or smoking status between the two groups. Acute coronary syndrome was the first manifestation in 14 patients. Coronary angiography showed 2.56 stenosis per patient, with a single vessel involvement in one-half. Percutaneous angioplasty was performed in all cases, with stenting in 11. After a mean follow-up of 36 months, 14 patients remain alive. Restenosis (n=4) occurred in 3 patients (PTCA 3; stenting 4). All 14 patients are free of heart failure symptoms. Their mean left ventricular ejection fraction is 61%.
Conclusions
A higher coronary-event rate is observed among HIV-infected patients, associated with drug-induced metabolic disturbances and a high prevalence of tobacco smoking. However, treatment and prognosis of acute myocardial infarction has no specificity.
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References
Dube MP, Sprecher D, Henry WK, Aberg JA, Torrriani FJ, Hodis HN, Schouten J, Levin J, Myers G, Zackin R, Nevin T, Currier JS (2000) Preliminary guidelines for the evaluation and management of dyslipidemia in adults infected with human immunodeficiency virus and receiving antiretroviral therapy: recommendations of the Adult AIDS Clinical Trial Group Cardiovascular Disease Focus Group. Clin Infect Dis 31:1216–1224
Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chisholm DJ, Cooper DA (1999) Diagnosis, prediction and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidemia and diabetes mellitus: a cohort study. Lancet 353:2093–2099
Tsiodras S, Mantzoros C, Hammer S, Samore M (2000) Effects of protease inhibitors on hyperglycemia, hyperlipidemia and lipodystrophy: a 5-year cohort study. Arch Intern Med 160:2050–2056
Henry K, Melroe H, Huebsh J, Hermundson J, Levine C, Swensen L, Daley J (1998) Severe premature coronary artery disease with protease inhibitors. Lancet 351:1328
Behrens G, Schmidt H, Meyer D, Stoll M, Schmidt RE (1998) Vascular complications associated with the use of HIV protease inhibitors. Lancet 351:1958
Flynn TE, Bricker LA (1999) Myocardial infarction in HIV-infected men receiving protease inhibitors. Ann Intern Med 131:548
Barbaro G, Barbarini G, Pellicelli AM (2001) HIV-associated coronary arteritis in a patient with fatal myocardial infarction. N Engl J Med 344:1799–1800
Ryan TJ, Antman EM, Brooks NH, Califf Rm, Hilis LD, Hiratzka LF, Rapaport E, Riegel B, Russel RO, Smith EE 3rd, Weaver WD, Gibbons RJ, Alpert JS, Eagle KA, Gardner TJ, Garson A Jr, Gregoratos G, Ryan TJ, Smith SC Jr (1999) ACC/AHA Guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations. Circulation 100:1016–1030
Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P (1999) Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-years results from 37 WHO MONICA Project populations. Lancet 353:1547–1557
Cambou JP, Genes N, Vaur L, Renault M, Etienne S, Ferrieres J, Danchin N (1997) Epidémiologie de l'infarctus du myocarde en France. Arch Mal Coeur Vaiss 90:1511–1519
Andrejak M, Gras-Champel V, Pannier M, et al (2000) Coronary events in HIV-infected patients. 8th Annual Meeting of the European Society of Pharmacovigilance, Verona
Grundy SM, Pasternak R, Greenland P, Smith S, Fuster V (1999) Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations. Circulation 100:1481–1492
Marques-Vidal P, Cambou JP, Ferrieres J, Thomas D, Grenier O, Danchin N (2001) Distribution et prise en charge des facteurs de risque cardiovasculaires chez des patients coronariens: étude PREVENIR. Arch Mal Coeur Vaiss 94:673–980
Miller JI, Sperling LS, Agahterani A, Nell C, Weintraub WS (2001) Premature coronary artery disease: 15-year follow-up in patients under the age of forty. J Am Coll Cardiol 37:504A
Fallavollita JA, Brody AS, Bunnel IL, Kumar K, Canty JM (1994) Fast computed tomography detection of coronary calcification in the diagnosis of coronary artery disease: comparison with angiography in patients <50 years old. Circulation 89:285–290
Lapandry C (2001) Prise en charge pré-hospitalière de l'infarctus du myocarde en région francilienne. Arch Mal Coeur Vaiss 94 [Suppl 1]:7
Weintraub WS, Ghazzal ZM, Douglas JS Jr, Liberman HA, Morris DC, Cohen CL, King SB 3rd (1993) Long-term clinical follow-up in patients with angiographic restudy after successful angioplasty. Circulation 87:831–840
Libby P (1995) Molecular basis of acute coronary syndromes. Circulation 92:657–671
Carr A, Samaras K, Chisholm DJ, Cooper DA (1998) Pathogenesis of HIV-1 protease inhibitor-associated peripheral lipodystrophy, hyperlipidemia and insulin resistance. Lancet 352:1881–1833
Pierard D, Telenti A, Sudre P, Cheseaux JJ, Halfon P, Reymond MJ, Marcovina SM, Glauser MP, Nicod P, Darioli R, Mooser V (1999) Atherogenic dyslipidemia in HIV-infected individuals treated with protease inhibitors. Circulation 100:700–705
Best PJM, Edwards WD, Holmes DR, Lerman A (1997) Unique coronary arteriopathy associated with human immunodeficiency virus. J Am Coll Cardiol 31 [Suppl A]:272A
Paton P, Tabib F, Loire R, Tete R (1993) Coronary artery lesions and human immunodeficiency virus infection. Res Virol 144:225–231
Chalifoux LV, Simon MA, Pauley DR, McKey JJ, Wyands MS, Ringler DJ (1992) Arteriopathy in macaques infected with simian immunodeficiency virus. Lab Invest 67:338–349
Zietz C, Hotz B, Sturzl M, Rauch E, Penning R, Lohrs U (1996) Aortic endothelium in HIV-1 infection: chronic injury, activation and increased leucocyte adherence. Am J Pathol 149:1887–1998
Monsuez JJ, Vittecoq D, Dufaux J, Vicaut E (2000) Reduced reactive hyperemia in HIV-infected patients. J AIDS 25:434–442
Zhou X, Nicoletti A, Elhage R, Hansson G (2000) Transfer of CD4+ T cells aggravates atherosclerosis in immunodeficient apolipoprotein E knockout mice. Circulation 102:2919–2922
Mary-Krause M, Cotte L, Partisani M, Simon A, Costagliola D (2001) Impact of treatment with protease inhibitors on myocardial infarction occurrence in HIV-infected men. 8th Conference on Retroviruses and Opportunistic Infections, (abstract 657)
Klein D, Hurley L, Sorel M, S Sidney (2002) Do protease inhibitors increase the risk for coronary heart disease in patients with HIV1 infection. J AIDS15:471–477
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Escaut, L., Monsuez, J.J., Chironi, G. et al. Coronary artery disease in HIV infected patients. Intensive Care Med 29, 969–973 (2003). https://doi.org/10.1007/s00134-003-1740-0
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DOI: https://doi.org/10.1007/s00134-003-1740-0