RESUMO
ANTECEDENTES: La mayor supervivencia de los pacientes con infección por VIH gracias al tratamiento antirretroviral (TAR) se acompaña de una mayor frecuencia de enfermedad cardiovascular (ECV). Analizamos la prevalencia de los factores de riesgo cardiovascular (FRCV) y la estimación del riesgo de ECV en una cohorte de personas con infección por VIH en España. MÉTODOS: Estudio transversal, observacional de los FRCV en la cohorte española VACH de pacientes con infección por VIH que recibían TAR. RESULTADOS: Se evaluaron 15.559 pacientes con infección por VIH (76% varones; edad media: 46 años). Un 3,7% había experimentado al menos un evento de ECV. La prevalencia de FRCV era elevada: hiperlipidemia, 64%; tabaquismo, 47%; HTA, 22%; y diabetes, 16%. Según la escala Framingham, un 10,9% presentaba alto riesgo de ECV y un 28,8% riesgo moderado. De los pacientes con elevado riesgo de ECV, el 49% recibía inhibidores de proteasa y el 43% abacavir. Se usaron fármacos hipotensores en el 53% de los pacientes con diagnóstico de HTA, y fármacos antidiabéticos en el 2,6% de los pacientes con diabetes. CONCLUSIONES: Los FRCV tradicionales son frecuentes en los pacientes con infección por VIH con TAR en España, y una elevada proporción de ellos tiene riesgo moderado-alto de ECV. Por tanto, el control de los FRCV modificables en los pacientes con infección por VIH debería mejorarse y valorar el uso de fármacos con mejor perfil de riesgo cardiovascular
BACKGROUND: The increased survival of patients with HIV infection thanks to antiretroviral therapy (ART) is accompanied by a higher rate of cardiovascular disease (CVD). We analysed the prevalence of the cardiovascular risk factors (CRFs) and estimated the risk of CVD in a cohort of patients with HIV in Spain. METHODS: We conducted a cross-sectional, observational study of CRFs in the Spanish VACH cohort of patients with HIV who undergo ART. RESULTS: The study assessed 15,559 patients with HIV (76% men; mean age, 46 years). Some 3.7% had experienced at least 1 CVD event. The prevalence of CRFs was high (hyperlipidaemia, 64%; tobacco use, 47%; arterial hypertension, 22%; and diabetes, 16%). According to the Framingham scale, 10.9% of the patients presented a high CVD risk, and 28.8% presented a moderate risk. Of the patients with a high CVD risk, 49% took protease inhibitors and 43% took abacavir. Fifty-three percent of the patients diagnosed with arterial hypertension took antihypertensive drugs, and 2.6% of the patients with diabetes took antidiabetic agents. CONCLUSIONS: Classical CRFs are common in patients with HIV undergoing ART in Spain, and a large proportion of them have a moderate-high risk of CVD. Therefore, controlling the modifiable CRFs in patients with HIV should be improved, and the use of drugs with a better cardiovascular risk profile should be assessed
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doenças Cardiovasculares/induzido quimicamente , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Antirretrovirais/efeitos adversos , Estudos Transversais , Antirretrovirais/classificação , Doenças Cardiovasculares/sangue , Fatores SexuaisRESUMO
BACKGROUND: The increased survival of patients with HIV infection thanks to antiretroviral therapy (ART) is accompanied by a higher rate of cardiovascular disease (CVD). We analysed the prevalence of the cardiovascular risk factors (CRFs) and estimated the risk of CVD in a cohort of patients with HIV in Spain. METHODS: We conducted a cross-sectional, observational study of CRFs in the Spanish VACH cohort of patients with HIV who undergo ART. RESULTS: The study assessed 15,559 patients with HIV (76% men; mean age, 46 years). Some 3.7% had experienced at least 1 CVD event. The prevalence of CRFs was high (hyperlipidaemia, 64%; tobacco use, 47%; arterial hypertension, 22%; and diabetes, 16%). According to the Framingham scale, 10.9% of the patients presented a high CVD risk, and 28.8% presented a moderate risk. Of the patients with a high CVD risk, 49% took protease inhibitors and 43% took abacavir. Fifty-three percent of the patients diagnosed with arterial hypertension took antihypertensive drugs, and 2.6% of the patients with diabetes took antidiabetic agents. CONCLUSIONS: Classical CRFs are common in patients with HIV undergoing ART in Spain, and a large proportion of them have a moderate-high risk of CVD. Therefore, controlling the modifiable CRFs in patients with HIV should be improved, and the use of drugs with a better cardiovascular risk profile should be assessed.
RESUMO
La diabetes mellitus es una de las enfermedades con mayor impactoen la población española y en el sistema sanitario, como consecuenciade su elevada prevalencia y de los costes directos e indirectosque genera. La prevalencia de diabetes en pacientes concardiopatía isquémica en España es aproximadamente del 20%. Lafisiopatología y la repercusión clínica varían en función del lechovascular afectado. En pacientes con diabetes tipo 2, el desarrollo dela placa de ateroma no sólo es más rápido, sino que los mecanismosresponsables parecen diferir respecto a los de los pacientes nodiabéticos. En este escenario, las técnicas de imagen cardiaca adquierenun papel importante para detectar a los pacientes asintomáticoscon riesgo aterotrombótico alto. La ecocardiografía es actualmentela técnica de elección en la valoración inicial del paciente consíntomas o sospecha de disfunción cardiaca. La valoración medianteecocardiografía de la función sistólica y diastólica, basal y tras unesfuerzo, aporta información diagnóstica y pronóstica para el manejode los pacientes diabéticos. Sin embargo, a pesar de su potencialutilidad, el criterio para seleccionar a los pacientes diabéticos quepodrían beneficiarse de un cribado no invasivo de enfermedad coronariaes todavía muy controvertido, y se requieren estudios prospectivospara determinar cuáles son las pruebas de imagen cardiacamás útiles en estos pacientes(AU)
Diabetes mellitus is one of the diseases with higher impact in theSpanish community and health care system as a consequence of itshigh prevalence and their associated direct and indirect costs. Theprevalence of diabetes in patients with coronary disease in Spain isapproximately of 20%. Both physiopathology and clinical manifestationsare dependent on the location of vascular abnormalities. In patientswith type 2 diabetes, the development and progression of theatheroma plaque are not only more rapid but it seems that prevailingmechanisms are different than in non-diabetic patients. Therefore,cardiac imaging techniques may play a key role to detect asymptomaticpatients with high atherothrombotic risk. Currently, echocardiographyis the gold-standard technique for the initial valuation of thesymptomatic patient or with suspected cardiac dysfunction. Echocardiographicevaluation of systolic and diastolic ventricular functionboth at rest and under stress provides important diagnostic andprognostic information for the management of diabetic patients.However, despite its potential usefulness, the criterion to select thediabetic patients who might benefit from a non invasive screening ofcoronary disease is still controversial and prospective studies arenecessary to determine which imaging techniques are more useful indiabetic patients(AU)
