TY - JOUR
T1 - Presence of the Metabolic Syndrome Is Not a Better Predictor of Cardiovascular Disease Than the Sum of Its Components in HIV-Infected Individuals: Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study
AU - Worm, S.W.
AU - Sabin, C.A.
AU - Reiss, P.
AU - El-Sadr, W.
AU - Monforte, A.D.
AU - Pradier, C.
AU - Thiebaut, R.
AU - Law, M.
AU - Rickenbach, M.
AU - De Wit, S.
AU - Lundgren, J.D.
AU - Friis-Møller, N.
AU - Torres, Ferran
N1 - Cited By :26
Export Date: 17 February 2022
CODEN: DICAD
Correspondence Address: Worm, S. W.; Copenhagen HIV Programme, , Copenhagen, Denmark; email: [email protected]
Chemicals/CAS: Anti-HIV Agents; Cholesterol, HDL; Triglycerides
References: Carr, A., Samaras, K., Burton, S., Law, M., Freund, J., Chisholm, D.J., Cooper, D.A., A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors (1998) AIDS, 12, pp. F51-F58; De Wit, S., Sabin, C.A., Weber, R., Worm, S.W., Reiss, P., Cazanave, C., El-Sadr, W., Phillips, A., Incidence and risk factors for new-onset diabetes in HIV-infected patients: The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study (2008) Diabetes Care, 31, pp. 1224-1229; Jerico, C., Knobel, H., Montero, M., Ordonez-Llanos, J., Guelar, A., Gimeno, J.L., Saballs, P., Pedro-Botet, J., Metabolic syndrome among HIV-infected patients: Prevalence, characteristics, and related factors (2005) Diabetes Care, 28, pp. 132-137; Jacobson, D.L., Tang, A.M., Spiegelman, D., Thomas, A.M., Skinner, S., Gorbach, S.L., Wanke, C., Incidence of metabolic syndrome in a cohort of HIV-infected adults and prevalence relative to the US population (National Health and Nutrition Examination Survey) (2006) J Acquir Immune Defic Syndr, 43, pp. 458-466; Mondy, K., Overton, E.T., Grubb, J., Tong, S., Seyfried, W., Powderly, W., Yarasheski, K., Metabolic syndrome in HIV-infected patients from an urban, midwestern US out- patient population (2007) Clin Infect Dis, 44, pp. 726-734; Samaras, K., Wand, H., Law, M., Emery, S., Cooper, D., Carr, A., Prevalence of metabolic syndrome in HIV-infected patients receiving highly active antiretroviral therapy using International Diabetes Foundation and Adult Treatment Panel III criteria: Associations with insulin resistance, disturbed body fat compartmentalization, elevated C-reactive protein, and [corrected] hypoadiponectinemia (2007) Diabetes Care, 30, pp. 113-119; Lewden, D., Tay, M., Rosenthal, E., Burty, E., Bonnet, F., Burty, C., Costagliola, D., Causes of death among HIV-infected adults in France in 2005 and evolution since 2000 (2007) Proceedings of the 14th Conference on Retroviruses and Opportunistic Infections, , Los Angeles, CA, Poster 976; Evaluation and Treatment on High Blood Cholesterol in Adults: Executive summary of the Third Report of the National Cholesterol Educational Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Cholesterol in Adults (Adult Treatment Panel III) (2001) JAMA, 285, pp. 2486-2497. , Expert Panel on Detection; Hunt, K.J., Resendez, R.G., Williams, K., Haffner, S.M., Stern, M.P., National Cholesterol Education Program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study (2004) Circulation, 110, pp. 1251-1257; Dekker, J.M., Girman, C., Rhodes, T., Nijpels, G., Stehouwer, C.D., Bouter, L.M., Heine, R.J., Metabolic syndrome and 10-year cardiovascular disease risk in the Hoorn Study (2005) Circulation, 112, pp. 666-673; Kahn, R., Buse, J., Ferrannini, E., Stern, M., The metabolic syndrome: Time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes (2005) Diabetes Care, 28, pp. 2289-2304; Friis-Moller, N., Reiss, P., Sabin, C.A., Weber, R., Monforte, A., El-Sadr, W., Thiebaut, R., Lundgren, J.D., Class of antiretroviral drugs and the risk of myocardial infarction (2007) N Engl J Med, 356, pp. 1723-1735; Evaluation, and Treatment of High Blood Cholesterol in Adults (2002) Circulation, 106, pp. 3143-3421. , Third report of the National Cholesterol Education Program Expert Panel on Detection; Friis-Moller, N., Sabin, C.A., Weber, R., d'Arminio, M.A., El-Sadr, W.M., Reiss, P., Thiebaut, R., Lundgren, J.D., Combination antiretroviral therapy and the risk of myocardial infarction (2003) N Engl J Med, 349, pp. 1993-2003; Sattar, N., Gaw, A., Scherbakova, O., Ford, I., O'Reilly, D.S., Haffner, S.M., Isles, C., Shepherd, J., Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study (2003) Circulation, 108, pp. 414-419; Sundstrom, J., Riserus, U., Byberg, L., Zethelius, B., Lithell, H., Lind, L., Clinical value of the metabolic syndrome for long term prediction of total and cardiovascular mortality: Prospective, population based cohort study (2006) BMJ, 332, pp. 878-882; Sattar, N., McConnachie, A., Shaper, A.G., Blauw, G.J., Buckley, B.M., de Craen, A.J., Ford, I., Wannamethee, S.G., Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies (2008) Lancet, 371, pp. 1927-1935; Wand, H., Calmy, A., Carey, D.L., Samaras, K., Carr, A., Law, M.G., Cooper, D.A., Emery, S., Metabolic syndrome, cardiovascular disease and type 2 diabetes mellitus after initiation of antiretroviral therapy in HIV infection (2007) AIDS, 21, pp. 2445-2453; Glass, T.R., Ungsedhapand, C., Wolbers, M., Weber, R., Vernazza, P.L., Rickenbach, M., Furrer, H., Bucher, H.C., Prevalence of risk factors for cardiovascular disease in HIV-infected patients over time: The Swiss HIV Cohort Study (2006) HIV Med, 7, pp. 404-410; Sabin, C.A., Worm, S.W., Weber, R., Reiss, P., El-Sadr, W., Dabis, F., De, W.S., Lundgren, J.D., Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: A multi-cohort collaboration (2008) Lancet, 371, pp. 1417-1426; Lundgren, J.D., Neuhaus, J., Babiker, A., Cooper, D., Duprez, D., El-Sadr, W., Emery, S., Neaton, J.D., Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients (2008) AIDS, 22, pp. F17-F24; Danesh, J., Kaptoge, S., Mann, A.G., Sarwar, N., Wood, A., Angleman, S.B., Wensley, F., Gudnason, V., Long-term interleukin-6 levels and subsequent risk of coronary heart disease: Two new prospective studies and a systematic review (2008) PLo S Med, 5, pp. e78; Gale, E.A., Should we dump the metabolic syndrome? Yes (2008) BMJ, 336, p. 640; Alberti, K.G., Zimmet, P.Z., Should we dump the metabolic syndrome? (2008) BMJ, 336, p. 641; Lundgren, J.D., Battegay, M., Behrens, G., De, W.S., Guaraldi, G., Katlama, C., Martinez, E., Vigano, A., European AIDS Clinical Society (EACS) guidelines on the prevention and management of metabolic diseases in HIV (2008) HIV Med, 9, pp. 72-81
PY - 2009/3
Y1 - 2009/3
N2 - OBJECTIVE - It is much debated whether the metabolic syndrome contributes additional information over and above that provided by the individual components of the syndrome alone. Among HIV-infected individuals, we investigated whether any particular combinations of the components included in the definition of the metabolic syndrome are associated with a higher risk of cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS- We followed 33,347 HIV-infected individuals in a prospective observational study. The effect of combinations of components of the metabolic syndrome (low HDL cholesterol, high triglycerides, high BMI, hypertension, and diabetes) on the risk of CVD was assessed by Poisson regression incorporating interactions between each component pair and adjusting for age, sex, family history of CVD, smoking status, calendar year, and exposure to antiretroviral therapy. We reduced the risk of type 1 errors by randomly splitting the data set for training (70% of sample) and validation (remaining 30%). RESULTS- In the training data set, 671 patients experienced a CVD event over 110,652 person-years. Unadjusted, the presence of metabolic syndrome at study enrollment (≥ of the factors) was associated with a 2.89 higher risk of CVD (95% CI 2.34-3.59; P = 0.0001) compared with individuals without the metabolic syndrome. After adjustment for the individual components, the metabolic syndrome as an entity no longer predicted the risk of CVD (adjusted relative risk 0.85; 95% CI 0.61-1.17; P = 0.32). No significant positive interactions were found among the components of the metabolic syndrome. CONCLUSIONS - The presence of the metabolic syndrome in HIV-infected individuals did not appear to increase the CVD risk over and above that conferred by the components of the syndrome separately. © 2009 by the American Diabetes Association.
AB - OBJECTIVE - It is much debated whether the metabolic syndrome contributes additional information over and above that provided by the individual components of the syndrome alone. Among HIV-infected individuals, we investigated whether any particular combinations of the components included in the definition of the metabolic syndrome are associated with a higher risk of cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS- We followed 33,347 HIV-infected individuals in a prospective observational study. The effect of combinations of components of the metabolic syndrome (low HDL cholesterol, high triglycerides, high BMI, hypertension, and diabetes) on the risk of CVD was assessed by Poisson regression incorporating interactions between each component pair and adjusting for age, sex, family history of CVD, smoking status, calendar year, and exposure to antiretroviral therapy. We reduced the risk of type 1 errors by randomly splitting the data set for training (70% of sample) and validation (remaining 30%). RESULTS- In the training data set, 671 patients experienced a CVD event over 110,652 person-years. Unadjusted, the presence of metabolic syndrome at study enrollment (≥ of the factors) was associated with a 2.89 higher risk of CVD (95% CI 2.34-3.59; P = 0.0001) compared with individuals without the metabolic syndrome. After adjustment for the individual components, the metabolic syndrome as an entity no longer predicted the risk of CVD (adjusted relative risk 0.85; 95% CI 0.61-1.17; P = 0.32). No significant positive interactions were found among the components of the metabolic syndrome. CONCLUSIONS - The presence of the metabolic syndrome in HIV-infected individuals did not appear to increase the CVD risk over and above that conferred by the components of the syndrome separately. © 2009 by the American Diabetes Association.
KW - high density lipoprotein cholesterol
KW - triacylglycerol
KW - adult
KW - article
KW - body mass
KW - cardiovascular disease
KW - cardiovascular risk
KW - controlled study
KW - diabetes mellitus
KW - female
KW - human
KW - Human immunodeficiency virus infected patient
KW - Human immunodeficiency virus infection
KW - hypertension
KW - major clinical study
KW - male
KW - metabolic syndrome X
KW - prospective study
KW - risk reduction
KW - Adult
KW - Anti-HIV Agents
KW - Body Mass Index
KW - Cardiovascular Diseases
KW - Cholesterol, HDL
KW - Female
KW - HIV Infections
KW - Humans
KW - Hypertension
KW - Male
KW - Metabolic Syndrome X
KW - Middle Aged
KW - Prospective Studies
KW - Triglycerides
UR - http://care.diabetesjournals.org/cgi/doi/10.2337/dc08-1394
U2 - 10.2337/dc08-1394
DO - 10.2337/dc08-1394
M3 - Article
SN - 1935-5548
VL - 32
SP - 474
EP - 480
JO - Diabetes Care
JF - Diabetes Care
IS - 3
ER -
