Original article
Metabolic syndrome: A major risk factor for atherosclerosis in HIV-infected patients (SHIVA study)Le syndrome métabolique : un risque cardiovasculaire majeur chez les patients séropositifs pour le VIH

https://doi.org/10.1016/j.lpm.2007.09.022Get rights and content

Summary

Objective

Metabolic syndrome (MetS) is directly related to a high incidence of cardiovascular disease in the general population. The association is more doubtful among HIV-infected patients, although MetS has an elevated prevalence in this population. We explored the impact of MetS on early atherosclerosis markers.

Research design and methods

All HIV-infected outpatients followed at the Brest University Hospital were included in this cross-sectional hospital-based study (SHIVA study, France) (n = 154). The MetS status (NCEP ATPIII definition, at least three of these five criteria: fasting glucose, triglycerides, HDL-C, waist circumference and hypertension.) of each patient was analyzed (Mann-Whitney test) according to carotid intima-media thickness, number of plaques, and a combined cardiovascular score.

Results

After exclusion of 6 patients treated with statins or insulin or both, MetS status was available for 140 (90.9%) patients and positive for 10 (7.1%). MetS status was due predominantly to blood glucose and triglyceride levels and was strongly correlated with all atherosclerosis markers (p  0.01).

Conclusion

The MetS prevalence in this population is low for a group with HIV infection, even after inclusion of the statin-treated patients (11.4%), but remains higher than among the general population. MetS in this population is probably a heterogeneous cluster of side effects of antiretroviral therapy (high triglycerides, lower HDL-C, and hypertension) and direct effects of HIV (glucose disturbances). Because it is strongly linked to the presence of plaque and intimal thickness, it is a pertinent criterion for deciding about cardiovascular prevention.

Résumé

Objectif

S’il est admis que le syndrome métabolique représente un facteur de risque cardiovasculaire, sa responsabilité dans l’athérosclérose précoce des patients séropositifs pour le VIH est moins claire. Sa forte prévalence dans cette population justifie d’explorer son impact sur les marqueurs précoces d’athérosclérose.

Matériel et méthodes

Tous les patients séropositifs pour le VIH de plus de 18 ans inclus dans l’étude transversale Shiva (n = 154), à l’exclusion de 6 patients sous hypolipémiant et/ou hypoglycémiant, ont été classés, selon la définition de la NCEP ATPIII, avec ou sans syndrome métabolique. Les données échographiques carotidiennes (l’épaisseur intima-média, la présence et le nombre de plaque) et un score cardiovasculaire combiné, ont été comparés entre les 2 groupes par Mann-Whitney test.

Résultats

Parmi les 140 patients dont les données sont exploitables, 10 (7,1 %) présentent un syndrome métabolique, dont l’hyperglycémie et l’hypertriglycéridémie sont les composantes les plus fréquentes. Ces patients ont des marqueurs d’athérosclérose statistiquement (p  0,01) plus élevés.

Discussion

La prévalence du syndrome métabolique, si elle reste supérieure à celle de la population générale, est inférieure aux données antérieures de la littérature, même après inclusion des 6 patients en prophylaxie (11,4 %). Ce syndrome métabolique, qui est probablement un agrégat hétérogène de complication des traitements antirétroviraux (hypertriglycéridémie, hypertension, hypoHDLc) et de la pathologie VIH (hyperglycémie), représente, comme dans la population générale, un facteur de risque cardiovasculaire majeur qui justifie son dépistage et sa prévention.

Section snippets

What was already known

  • The high incidence of cardiovascular disease among people with HIV infection.

  • The high prevalence of metabolic syndrome in people with HIV infection.

  • The direct relation between metabolic syndrome and cardiovascular disease in the general population.

What this article adds

  • The prevalence of MetS (10.9%) was much lower than previously reported in patients with HIV but remained higher than among the general population (4.8%).

  • Metabolic syndrome status depends on a combination of adverse events due to antiretroviral treatment and HIV-associated dysfunctions.

  • MetS status was strongly linked to cardiovascular disease markers and can be used for determining the need for primary cardiovascular prevention.

Methods

The cross-sectional SHIVA study [5], which was approved by the local ethics committee, enrolled 154 (96.5%) patients from a cohort of HIV outpatients under follow-up at Brest University Hospital (figure 1). This study took place from January through April 2003. After patients provided informed consent, the following information was collected:

  • blood levels (after overnight fast, > 12 hours) of triglycerides, glucose, total cholesterol, HDL cholesterol [HDL-C]

  • anthropometric and other clinical data:

Results

MetS status was available for 140 patients (86.9%). Ten patients (7.1%) met the NCEP definition. Positive status for MetS was strongly correlated with all atherosclerosis markers (p  0.01). Only age, total cholesterol, and BMI, of the MetS-independent atherosclerosis risk factors, and viral load, of the HIV parameters, were correlated with MetS status (table I). An interaction (p > 0.05) was observed between the variables correlated with MetS status. Moreover, MetS status was not associated with

Discussion

Despite the inclusion of 6 patients with a history of CVD (10.9%), the prevalence of MetS (7.4%) was much lower than those previously reported in HIV-infected patients — ranging from 17% to 45% [8], [9], [10]. Nevertheless it is higher than MetS prevalence in the French general population, reported to be 4.8% [11] for a population of the same age and using the same definition as the Spanish HIV patient cohort with a prevalence of 17% [10].

This low prevalence is not explained by a high rate of

Conflicts of Interest

none

Funding

This project received funding from a PHRC 2003 grant.

Remarks

The SHIVA study was approved by the Brest institutional review board (CCPPRB). The database has been reported to the French Data Protection Authority (CNIL), as required by statute.

Luc de Saint Martin designed the study, analyzed the data and participated in writing the paper

Elisabeth Pasquier analyzed the data and participated in writing the paper

Nathalie Roudaut participated in writing the paper.

Olivier Vandhuick (IMT), Sophie Vallet (HIV status), Véronique Bellein (lipodystrophy) and Luc

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