title: Evaluation of myocardial infarction and coronary artery disease in subjects taking lopinavir/ritonavir: a study using clinical trial and pharmacovigilance databases.
abstract: OBJECTIVE
  There is growing interest in studying age-related diseases, such as coronary artery disease (CAD) and resulting myocardial infarction (MI) in HIV-infected patients. While some cohort studies indicate that several antiretrovirals (ARVs), including the protease inhibitor lopinavir/ ritonavir (LPV/r), are associated with an increased relative risk (RR) of MI, other studies show a reduction of MI and CAD in subjects taking ARVs when compared with HIV+ patients not taking ARV therapy. This manuscript reviews data from Abbott-sponsored clinical trials and pharmacovigilance reporting system.
  
  
  METHODS
  A systematic search was performed to retrieve cases of MI and CAD in Abbott’s clinical trial and pharmacovigilance safety databases. The rates of MI and CAD, and risk factors for the events were reviewed in detail.
  
  
  RESULTS
  The rate of MI and CAD per 1,000 patient treatment years (PTY) was 1.24 (95% CI = 0.40 - 2.90) and 2.74 (95% CI = 1.37 - 4.90), respectively, for subjects taking LPV/r during clinical trials. The frequency of pharmacovigilance reports of MI and CAD were 2.9 per 100,000 PTY and 3.6 per 100,000 PTY, respectively. Most subjects who had MI and CAD events had multiple baseline risk factors.
  
  
  CONCLUSIONS
  Relatively few subjects experienced MI or CAD during Abbott-sponsored clinical trials of LPV/r. Analysis of clinical trial and pharmacovigilance data did not indicate an increased risk of MI or CAD associated with LPV/r compared with the general population. In general, the subjects that experienced MI or CAD had known traditional risk factors suggesting that addressing modifiable risk factors could decrease the risk of MI or CAD. ARVs have not been thoroughly studied in subjects at high risk for MI and CAD, and further studies of this population could identify whether starting ARVs affects the incidences of cardic events in subjects with many traditional risk factors
authors.affiliation: Abbott, Abbott Park, IL 60046-6145, USA. barbara.dasilva@abbott.com
authors.forename: Barbara
authors.initials: B
authors.lastname: Da Silva
authors.forename: Jean
authors.initials: J
authors.lastname: Tschampa
authors.forename: Jörg
authors.initials: J
authors.lastname: Beron
authors.forename: Linda
authors.initials: L
authors.lastname: Fredrick
authors.forename: Meenal
authors.initials: M
authors.lastname: Patwardhan
authors.forename: Woodie
authors.initials: W
authors.lastname: Zachry
authors.forename: William C
authors.initials: WC
authors.lastname: Woodward
authors.forename: Michael
authors.initials: M
authors.lastname: Norton
authors.forename: Angela
authors.initials: A
authors.lastname: Nilius
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D061466:Lopinavir / Q000009:adverse effects*; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D060735:Pharmacovigilance; D012307:Risk Factors; D019438:Ritonavir / Q000009:adverse effects*
chemical_list: D019380:Anti-HIV Agents; D061466:Lopinavir; D019438:Ritonavir