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Impact of dyslipidemia associated with Highly Active Antiretroviral Therapy (HAART) on cardiovascular risk and life expectancy.

Abstract

We investigated the effect of dyslipidemia associated with highly active antiretroviral therapy on cardiovascular risk and life expectancy among patients who had the human immunodeficiency virus. Dyslipidemia estimates were based on results from a phase 2 randomized trial that compared lipid changes after 32 weeks of therapy with atazanavir with those with nelfinavir (each in combination with stavudine and lamivudine). The resultant increased coronary risk was estimated using Framingham risk equations, and change in life expectancy (after adjustment for mortality due to human immunodeficiency virus) was based on the cardiovascular life expectancy model, which is based on a published Markov's model. Levels of total cholesterol and low-density lipoprotein cholesterol increased significantly more among patients who used nelfinavir (+24% and +28%) than among those who used atazanavir (+4% and +1%). This dyslipidemia increased the risk of coronary disease by 50% over 10 years. The absence of dyslipidemia was estimated to preserve life expectancy 0.15 to 1.53 additional years depending on a patient's age, gender, and other risk factors. There are increasing reports of dyslipidemia and cardiovascular events associated with highly active antiretroviral therapy. Significant increases in blood lipid levels observed with some protease inhibitors are associated with an increase in calculated 10-year coronary risk. Accordingly, minimizing dyslipidemia associated with highly active antiretroviral therapy may preserve life expectancy among adults who have the human immunodeficiency virus.

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  • Authors+Show Affiliations

    ,

    Centre for the Analysis of Cost-Effective Care, Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Department of Medicine, McGill University, Montreal, Quebec, Canada. steven.grover@mcgill.ca

    , ,

    Source

    The American journal of cardiology 95:5 2005 Mar 01 pg 586-91

    MeSH

    Adult
    Aged
    Antiretroviral Therapy, Highly Active
    Atazanavir Sulfate
    Cardiovascular Diseases
    Female
    HIV Infections
    Humans
    Hyperlipidemias
    Lamivudine
    Life Expectancy
    Male
    Markov Chains
    Middle Aged
    Nelfinavir
    Oligopeptides
    Pyridines
    Risk Factors
    Stavudine

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    15721096

    Citation

    Grover, Steven A., et al. "Impact of Dyslipidemia Associated With Highly Active Antiretroviral Therapy (HAART) On Cardiovascular Risk and Life Expectancy." The American Journal of Cardiology, vol. 95, no. 5, 2005, pp. 586-91.
    Grover SA, Coupal L, Gilmore N, et al. Impact of dyslipidemia associated with Highly Active Antiretroviral Therapy (HAART) on cardiovascular risk and life expectancy. Am J Cardiol. 2005;95(5):586-91.
    Grover, S. A., Coupal, L., Gilmore, N., & Mukherjee, J. (2005). Impact of dyslipidemia associated with Highly Active Antiretroviral Therapy (HAART) on cardiovascular risk and life expectancy. The American Journal of Cardiology, 95(5), pp. 586-91.
    Grover SA, et al. Impact of Dyslipidemia Associated With Highly Active Antiretroviral Therapy (HAART) On Cardiovascular Risk and Life Expectancy. Am J Cardiol. 2005 Mar 1;95(5):586-91. PubMed PMID: 15721096.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Impact of dyslipidemia associated with Highly Active Antiretroviral Therapy (HAART) on cardiovascular risk and life expectancy. AU - Grover,Steven A, AU - Coupal,Louis, AU - Gilmore,Norbert, AU - Mukherjee,Jayanti, PY - 2004/08/16/received PY - 2004/11/09/revised PY - 2004/11/09/accepted PY - 2005/2/22/pubmed PY - 2005/3/25/medline PY - 2005/2/22/entrez SP - 586 EP - 91 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 95 IS - 5 N2 - We investigated the effect of dyslipidemia associated with highly active antiretroviral therapy on cardiovascular risk and life expectancy among patients who had the human immunodeficiency virus. Dyslipidemia estimates were based on results from a phase 2 randomized trial that compared lipid changes after 32 weeks of therapy with atazanavir with those with nelfinavir (each in combination with stavudine and lamivudine). The resultant increased coronary risk was estimated using Framingham risk equations, and change in life expectancy (after adjustment for mortality due to human immunodeficiency virus) was based on the cardiovascular life expectancy model, which is based on a published Markov's model. Levels of total cholesterol and low-density lipoprotein cholesterol increased significantly more among patients who used nelfinavir (+24% and +28%) than among those who used atazanavir (+4% and +1%). This dyslipidemia increased the risk of coronary disease by 50% over 10 years. The absence of dyslipidemia was estimated to preserve life expectancy 0.15 to 1.53 additional years depending on a patient's age, gender, and other risk factors. There are increasing reports of dyslipidemia and cardiovascular events associated with highly active antiretroviral therapy. Significant increases in blood lipid levels observed with some protease inhibitors are associated with an increase in calculated 10-year coronary risk. Accordingly, minimizing dyslipidemia associated with highly active antiretroviral therapy may preserve life expectancy among adults who have the human immunodeficiency virus. SN - 0002-9149 UR - https://www.unboundmedicine.com/medline/citation/15721096/Impact_of_dyslipidemia_associated_with_Highly_Active_Antiretroviral_Therapy__HAART__on_cardiovascular_risk_and_life_expectancy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(04)01775-8 DB - PRIME DP - Unbound Medicine ER -