Scandinavian Journal of Infectious Diseases
ISSN: 0036-5548 (Print) 1651-1980 (Online) Journal homepage: http://www.tandfonline.com/loi/infd19
Predicted cardiovascular risk in HIV-infected patients Michael Scott Abers To cite this article: Michael Scott Abers (2014) Predicted cardiovascular risk in HIV-infected patients, Scandinavian Journal of Infectious Diseases, 46:3, 240-240 To link to this article: http://dx.doi.org/10.3109/00365548.2013.853882
Published online: 25 Nov 2013.
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Date: 05 November 2015, At: 17:27
Scandinavian Journal of Infectious Diseases, 2014; 46: 240
LETTER TO THE EDITOR
Predicted cardiovascular risk in HIV-infected patients
MICHAEL SCOTT ABERS
Downloaded by [University of Pennsylvania] at 17:27 05 November 2015
From the Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
To the Editor, In a recent case–control study, Kim et al. compared the predicted 10-y cardiovascular mortality between HIV-infected and uninfected patients [1]. Applying the Framingham risk score (FRS), the groups did not differ in predicted 10-y cardiovascular mortality (7% in both groups). While the authors should be commended for their efforts, several concerns remain. Importantly, the study did not control for a family history of cardiovascular disease. Calvo-Sánchez et al. [2] reported that family history is the greatest contributor to cardiovascular risk in HIV patients, higher than diabetes, hypertension, or smoking. Furthermore, the attributable risk of smoking was significantly higher in HIV-infected compared to uninfected patients, which supports the notion that FRS underestimates cardiovascular risk in HIV patients. The inclusion criteria used by Kim et al. limited enrollment to HIV patients who regularly attend appointments at 3-month intervals. This requirement represents an important source of selection bias by selecting for adherent HIV patients, which might not be representative of the greater population [3]. For this cross-sectional study, including all HIV patients would account for variations in patient behavior, thereby improving generalizability. Also, antiretroviral adherence requires behavioral traits that are likely associated with adherence to other interventions, such as cardiovascular risk reduction. Although the inclusion criteria for controls are not mentioned, appointments at 3-month intervals are unlikely in
healthy individuals. Greater exposure to healthcare providers in HIV patients compared to healthy controls, might also cause a higher prevalence of statin prescriptions. Discrepancies in statin use would explain the differences in lipid profiles, and therefore FRS. Even with equal rates of statin prescriptions, adherence would likely differ, due to both selection bias and drug interactions [4]. Limitations notwithstanding, Kim et al. provide convincing evidence that traditional cardiovascular risk factors might play a less important role in HIV patients. Declaration of interest: The author declares no conflict of interest. No funding was obtained for this article.
References [1] Kim SB, Kim YC, Kim MH, Song JE, Oh DH, Ahn JY, et al. A comparison of the predicted risk for cardiovascular disease between HIV-infected and uninfected persons in Korea. Scand J Infect Dis 2013 Aug 23. [Epub ahead of print] [2] Calvo-Sánchez M, Perelló R, Pérez I, Mateo MG, Junyent M, Laguno M, et al. Differences between HIV-infected and uninfected adults in the contributions of smoking, diabetes and hypertension to acute coronary syndrome: two parallel case–control studies. HIV Med 2013;14:40–8. [3] O’Connor JL, Gardner EM, Mannheimer SB, Lifson AR, Esser S, Telzak EE, et al. Factors associated with adherence amongst 5295 people receiving antiretroviral therapy as part of an international trial. J Infect Dis 2013;208:40–9. [4] Chong PH, Seeger JD, Franklin C. Clinically relevant differences between the statins: implications for therapeutic selection. Am J Med 2001;111:390–400.
Correspondence: Michael Scott Abers, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. Tel: ⫹ 1 954 612 7742. Fax: ⫹ 1 713 798 4600. E-mail: [email protected] (Received 30 September 2013 ; accepted 3 October 2013) ISSN 0036-5548 print/ISSN 1651-1980 online © 2014 Informa Healthcare DOI: 10.3109/00365548.2013.853882
ISSN: 0036-5548 (Print) 1651-1980 (Online) Journal homepage: http://www.tandfonline.com/loi/infd19
Predicted cardiovascular risk in HIV-infected patients Michael Scott Abers To cite this article: Michael Scott Abers (2014) Predicted cardiovascular risk in HIV-infected patients, Scandinavian Journal of Infectious Diseases, 46:3, 240-240 To link to this article: http://dx.doi.org/10.3109/00365548.2013.853882
Published online: 25 Nov 2013.
Submit your article to this journal
Article views: 78
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=infd19 Download by: [University of Pennsylvania]
Date: 05 November 2015, At: 17:27
Scandinavian Journal of Infectious Diseases, 2014; 46: 240
LETTER TO THE EDITOR
Predicted cardiovascular risk in HIV-infected patients
MICHAEL SCOTT ABERS
Downloaded by [University of Pennsylvania] at 17:27 05 November 2015
From the Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
To the Editor, In a recent case–control study, Kim et al. compared the predicted 10-y cardiovascular mortality between HIV-infected and uninfected patients [1]. Applying the Framingham risk score (FRS), the groups did not differ in predicted 10-y cardiovascular mortality (7% in both groups). While the authors should be commended for their efforts, several concerns remain. Importantly, the study did not control for a family history of cardiovascular disease. Calvo-Sánchez et al. [2] reported that family history is the greatest contributor to cardiovascular risk in HIV patients, higher than diabetes, hypertension, or smoking. Furthermore, the attributable risk of smoking was significantly higher in HIV-infected compared to uninfected patients, which supports the notion that FRS underestimates cardiovascular risk in HIV patients. The inclusion criteria used by Kim et al. limited enrollment to HIV patients who regularly attend appointments at 3-month intervals. This requirement represents an important source of selection bias by selecting for adherent HIV patients, which might not be representative of the greater population [3]. For this cross-sectional study, including all HIV patients would account for variations in patient behavior, thereby improving generalizability. Also, antiretroviral adherence requires behavioral traits that are likely associated with adherence to other interventions, such as cardiovascular risk reduction. Although the inclusion criteria for controls are not mentioned, appointments at 3-month intervals are unlikely in
healthy individuals. Greater exposure to healthcare providers in HIV patients compared to healthy controls, might also cause a higher prevalence of statin prescriptions. Discrepancies in statin use would explain the differences in lipid profiles, and therefore FRS. Even with equal rates of statin prescriptions, adherence would likely differ, due to both selection bias and drug interactions [4]. Limitations notwithstanding, Kim et al. provide convincing evidence that traditional cardiovascular risk factors might play a less important role in HIV patients. Declaration of interest: The author declares no conflict of interest. No funding was obtained for this article.
References [1] Kim SB, Kim YC, Kim MH, Song JE, Oh DH, Ahn JY, et al. A comparison of the predicted risk for cardiovascular disease between HIV-infected and uninfected persons in Korea. Scand J Infect Dis 2013 Aug 23. [Epub ahead of print] [2] Calvo-Sánchez M, Perelló R, Pérez I, Mateo MG, Junyent M, Laguno M, et al. Differences between HIV-infected and uninfected adults in the contributions of smoking, diabetes and hypertension to acute coronary syndrome: two parallel case–control studies. HIV Med 2013;14:40–8. [3] O’Connor JL, Gardner EM, Mannheimer SB, Lifson AR, Esser S, Telzak EE, et al. Factors associated with adherence amongst 5295 people receiving antiretroviral therapy as part of an international trial. J Infect Dis 2013;208:40–9. [4] Chong PH, Seeger JD, Franklin C. Clinically relevant differences between the statins: implications for therapeutic selection. Am J Med 2001;111:390–400.
Correspondence: Michael Scott Abers, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. Tel: ⫹ 1 954 612 7742. Fax: ⫹ 1 713 798 4600. E-mail: [email protected] (Received 30 September 2013 ; accepted 3 October 2013) ISSN 0036-5548 print/ISSN 1651-1980 online © 2014 Informa Healthcare DOI: 10.3109/00365548.2013.853882
