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Multicenter Study
. 2010 Aug;64(9):1252-9.
doi: 10.1111/j.1742-1241.2010.02424.x.

Cardiovascular risk evaluation and antiretroviral therapy effects in an HIV cohort: implications for clinical management: the CREATE 1 study

M Aboud  1 , A Elgalib, L Pomeroy, G Panayiotakopoulos, E Skopelitis, R Kulasegaram, C Dimian, F C Lampe, A Duncan, A S Wierzbicki, B S Peters
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Free PMC article
Multicenter Study

Cardiovascular risk evaluation and antiretroviral therapy effects in an HIV cohort: implications for clinical management: the CREATE 1 study

M Aboud et al. Int J Clin Pract. 2010 Aug.
Free PMC article

Abstract

Aims: The aim of this study is to determine the cardiovascular disease (CVD) risk profile of a large UK HIV cohort and how highly active antiretroviral therapy (HAART) affects this.

Methods: It is a cross-sectional study within a large inner city hospital and neighbouring district hospital. A total of 1021 HIV positive outpatients representative of the complete cohort and 990 who had no previous CVD were included in CVD risk analysis. We recorded demographics, HAART history and CVD risk factors. CVD and coronary heart disease (CHD) risks were calculated using the Framingham (1991) algorithm adjusted for family history.

Results: The non-CVD cohort (n = 990) was 74% men, 51% Caucasian and 73.1% were on HAART. Mean age was 41 +/- 9 years, systolic blood pressure 120 +/- 14 mmHg, total cholesterol 4.70 +/- 1.05 mmol/l, high-density lipoprotein-C 1.32 +/- 0.48 mmol/l and 37% smoked. Median CVD risk was 4 (0-56) % in men and 1.4 (0-37) % in women; CHD risks were 3.5 (0-36) % and 0.6 (0-16) %. CVD risk was > 20% in 6% of men and 1% of women and > 10% in 12% of men and 4% of women. CVD risk was higher in Caucasians than other ethnicities; the risk factor contributing most was raised cholesterol. For patients on their first HAART, increased CHD risk (26.2% vs. 6.5%; odds ratio 4.03, p < 0.001) was strongly related to the duration of therapy.

Conclusions: Modifiable risk factors, especially cholesterol, and also duration of HAART, were key determinants of CVD risk.

Discussion: Regular CHD and/or CVD risk assessment should be performed on patients with HIV, especially during HAART therapy. The effect of different HAART regimens on CHD risk should be considered when selecting therapy.

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Figures

Figure 1
Figure 1
Comparison of coronary heart disease (CHD) risk with length of treatment with highly active antiretroviral therapy (HAART) before and after adjustment for CHD risk factors. Contribution of CV risk factors to odds ratio (OR) for 10 year CHD risk > 10% by length of time on HAART. n = 243 first line HAART users only (OR Y-axis). First adjustment for age/gender; then sequentially for sBP, smoking and total Chol. The degree of OR drop reflects the contribution of that factor to risk in the first place. Biggest OR drop seen when TC corrected for
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