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).
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).


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.
Worm
Signe W
SW
Copenhagen HIV Programme, University of Copenhagen/Faculty of Health Science, Bldg 21.1/Blegdamsvej 3B, DK-2200 Copenhagen, Denmark. sww@cphiv.dk
De Wit
Stephane
S
Weber
Rainer
R
Sabin
Caroline A
CA
Reiss
Peter
P
El-Sadr
Wafaa
W
Monforte
Antonella D'Arminio
AD
Kirk
Ole
O
Fontas
Eric
E
Dabis
Francois
F
Law
Matthew G
MG
Lundgren
Jens D
JD
Friis-Møller
Nina
N
D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000009:adverse effects; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D048909:Diabetes Complications; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors
D019380:Anti-HIV Agents