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Diabetes Mellitus, Preexisting Coronary Heart Disease, and the Risk of Subsequent Coronary Heart Disease Events in Patients Infected With Human Immunodeficiency Virus The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D Study)

Worm, SW; De Wit, S; Weber, R; Sabin, CA; Reiss, P; El-Sadr, W; Monforte, AD; ... Friis-Moller, N; + view all (2009) Diabetes Mellitus, Preexisting Coronary Heart Disease, and the Risk of Subsequent Coronary Heart Disease Events in Patients Infected With Human Immunodeficiency Virus The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D Study). CIRCULATION , 119 (6) 805 - U75. 10.1161/CIRCULATIONAHA.108.790857.

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Abstract

Background-Although guidelines in individuals not infected with the human immunodeficiency virus (HIV) consider diabetes mellitus (DM) to be a coronary heart disease (CHD) equivalent, there is little information on its association with CHD in those infected with HIV. We investigated the impact of DM and preexisting CHD on the development of a new CHD episode among 33 347 HIV-infected individuals in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D Study).Methods and Results-Over 159 971 person-years, 698 CHD events occurred. After adjustment for gender, age, cohort, HIV transmission, ethnicity, family history of CHD, smoking, and calendar year, the rate of a CHD episode was 7.52 times higher (Poisson regression, 95% CI 6.02 to 9.39, P=0.0001) in those with preexisting CHD than in those without preexisting CHD, but it was only 2.41 times higher (95% CI 1.91 to 3.05, P=0.0001) in those with preexisting DM compared with those without DM. No statistical interactions were apparent between either diagnosis and sex; although older people with DM had an increased CHD rate compared with younger people, older people with preexisting CHD had a lower event rate. A statistically significant interaction between preexisting DM and CHD (P=0.003) suggested that the CHD rate in those with preexisting CHD and DM is lower than expected on the basis of the main effects alone.Conclusions-DM and preexisting CHD are both important risk factors for CHD events in HIV-infected individuals. There is a need for targeted interventions to reduce the risk of CHD in both high-risk groups of HIV-infected individuals. (Circulation. 2009;119:805-811.)

Type: Article
Title: Diabetes Mellitus, Preexisting Coronary Heart Disease, and the Risk of Subsequent Coronary Heart Disease Events in Patients Infected With Human Immunodeficiency Virus The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D Study)
DOI: 10.1161/CIRCULATIONAHA.108.790857
Keywords: coronary disease, diabetes mellitus, risk factors, human immunodeficiency virus, epidemiology, PRIOR MYOCARDIAL-INFARCTION, COMBINATION ANTIRETROVIRAL THERAPY, REVERSE-TRANSCRIPTASE INHIBITOR, LONG-TERM SURVIVAL, CARDIOVASCULAR-DISEASE, INSULIN-RESISTANCE, FOLLOW-UP, GLUCOSE DISPOSAL, PERIPHERAL LIPODYSTROPHY, PROTEASE INHIBITORS
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/168532
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