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LDL cholesterol and triglycerides levels are independent predictors of cardiovascular events in HIV-HCV co-infected patients: ANRS CO13-HEPAVIH
Abstract Content:
Background: HIV
infection increases the risk of mortality with cirrhosis, liver failure and
hepatocarcinoma in HCV co-infected patients. The risk and spectrum of cardiovascular
diseases (CVD) in this population are not well assessed with contradictory
previous results.
Methods: We used the French prospective multi-center HEPAVIH-ANRS CO13 cohort, to prospectively study all major (acute coronary syndrome, coronary revascularization, death by cardio-vascular cause, ischemic stroke) and minor (thrombo-embolic disease, peripheral arteriopathy, congestive heart failure) CVD events that occurred in the cohort, assess their incidence and screen CVD predictors. Chi 2 test was used for qualitative values and Wilcoxon test for quantitative values to screen potential CVD predictors. A Cox model was performed to identify CVD predictors among adjusted selected parameters with a p< 0,10 in univariate analysis.
Results: Among 1175 HIV-HCV co-infected patients (70,4% men, mean age: 45,0 years) included from January 2006 to January 2008 and followed till September 2013 (median follow-up: 57,6 months), we observed a total of 42 total CVD events for 28 patients experiencing a CVD event. The incidence of all events was 8.3 per 1000 person-years (CI95= 5,0-11,6) and 5.6 per 1000 person-years (CI95= 2,3-8,9) for a first event.
Atherosclerotic CVD events including 4 deaths by cardio-vascular cause, 10 acute coronary syndromes, 1 coronary revascularization, and 2 ischemic brain strokes were observed. Other CVD events were 8 peripheral arteriopathies and 3 thrombo-embolic venous diseases.
As compared with patients without CVD, patients who developed a CVD event were more frequently men (p=0.0092), had a higher median CD8 cell count (p=0.0394), were more frequently lipoatrophic (p=0.0399), had a higher total cholesterol level (p=0.0165), LDL cholesterol level (p=0.0132) and triglyceride level (p=0.0002). Otherwise, HCV eradication by antiretroviral treatment didn''t influence the occurrence of CVD events (p=0,1730).
A multivariate analysis identified serum LDL-cholesterol (RR=6.202 CI95= 1,580-24,352, p=0,0089) and triglyceride level (RR=2,010, CI95= 1,207-3,347, p=0,0076) as independent predictors of CVD.
Conclusions: In HIV-HCV co-infected patients, CVD events are mainly driven by atherosclerotic CVD particularly acute coronary syndromes and peripheral vascular diseases. Serum LDL-cholesterol and triglyceride levels appear as independent CVD predictors.
Methods: We used the French prospective multi-center HEPAVIH-ANRS CO13 cohort, to prospectively study all major (acute coronary syndrome, coronary revascularization, death by cardio-vascular cause, ischemic stroke) and minor (thrombo-embolic disease, peripheral arteriopathy, congestive heart failure) CVD events that occurred in the cohort, assess their incidence and screen CVD predictors. Chi 2 test was used for qualitative values and Wilcoxon test for quantitative values to screen potential CVD predictors. A Cox model was performed to identify CVD predictors among adjusted selected parameters with a p< 0,10 in univariate analysis.
Results: Among 1175 HIV-HCV co-infected patients (70,4% men, mean age: 45,0 years) included from January 2006 to January 2008 and followed till September 2013 (median follow-up: 57,6 months), we observed a total of 42 total CVD events for 28 patients experiencing a CVD event. The incidence of all events was 8.3 per 1000 person-years (CI95= 5,0-11,6) and 5.6 per 1000 person-years (CI95= 2,3-8,9) for a first event.
Atherosclerotic CVD events including 4 deaths by cardio-vascular cause, 10 acute coronary syndromes, 1 coronary revascularization, and 2 ischemic brain strokes were observed. Other CVD events were 8 peripheral arteriopathies and 3 thrombo-embolic venous diseases.
As compared with patients without CVD, patients who developed a CVD event were more frequently men (p=0.0092), had a higher median CD8 cell count (p=0.0394), were more frequently lipoatrophic (p=0.0399), had a higher total cholesterol level (p=0.0165), LDL cholesterol level (p=0.0132) and triglyceride level (p=0.0002). Otherwise, HCV eradication by antiretroviral treatment didn''t influence the occurrence of CVD events (p=0,1730).
A multivariate analysis identified serum LDL-cholesterol (RR=6.202 CI95= 1,580-24,352, p=0,0089) and triglyceride level (RR=2,010, CI95= 1,207-3,347, p=0,0076) as independent predictors of CVD.
Conclusions: In HIV-HCV co-infected patients, CVD events are mainly driven by atherosclerotic CVD particularly acute coronary syndromes and peripheral vascular diseases. Serum LDL-cholesterol and triglyceride levels appear as independent CVD predictors.