title: Determinants of developing widened spatial QRS-T angle in HIV-infected individuals: results from the Strategies for Management of Antiretroviral Therapy [SMART] Study.
abstract: BACKGROUND
  A widened electrocardiographic spatial QRS-T angle has been shown to be predictive of cardiovascular disease in HIV-infected individuals. However, determinants and risk factors of developing widened QRS-T angle over time in this population remain unknown.
  
  
  RESULTS
  Spatial QRS-T angle was automatically measured from standard electrocardiogram of 1444 HIV-infected individuals without baseline widened spatial QRS-T angle from the Strategies for Management of Antiretroviral Therapy [SMART], a clinical trial comparing two antiretroviral treatment strategies [Drug Conservation (DC) vs. Viral Suppression (VS)]. Conditional logistic regression analysis was used to examine the association between baseline characteristics and incident widened spatial QRS-T angle (a new angle>93° in males and>74° in females). During 2544 person-years of follow-up, 199 participants developed widened angle at a rate of 7.8 per 100 person-years. In unadjusted models, female sex, black race (vs. white), DC treatment strategy, current and past smokers (vs. never), history of alcohol abuse, greater body mass index, history of diabetes and higher levels of hs-C-reactive protein were associated with incident widened spatial QRS-T angle. When these variables were entered together in the same model with adjustment for demographics and treatment strategy, DC treatment strategy [OR (95% CI): 1.50 (1.09, 2.07)], female gender [1.69 (1.17, 2.45)], current and past smoking (vs. never) [2.49 (1.63, 3.81) and 1.93 (1.21, 3.09), respectively], and diabetes [2.28 (1.33, 3.91)] predicted incident widened spatial QRS-T angle.
  
  
  CONCLUSIONS
  Drug conservation treatment strategy, female gender, smoking, and diabetes are independently predictive of incident widened spatial QRS-T angle in HIV-infected individuals.
authors.affiliation: Department of Internal Medicine, Secion on Cardiology, Wake Forest School of Medicine, Winston Salem, NC, USA.
authors.forename: Farah Z
authors.initials: FZ
authors.lastname: Dawood
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Mollie P
authors.initials: MP
authors.lastname: Roediger
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Grandits
authors.affiliation: School of Medicine, Wake Forest Health Sciences, Winston Salem, NC, USA.
authors.forename: Dery
authors.initials: D
authors.lastname: Miller
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.affiliation: Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston Salem, NC, USA.
authors.forename: Zhu-Ming
authors.initials: ZM
authors.lastname: Zhang
authors.affiliation: Department of Medicine, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Hodder
authors.affiliation: Infectious Diseases Department, The Alfred Hospital and Monash University, Melbourne, Australia.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Hoy
authors.affiliation: Copenhagen HIV Program (CHIP), State University Hospital and University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Neaton
authors.affiliation: Department of Internal Medicine, Secion on Cardiology, Wake Forest School of Medicine, Winston Salem, NC, USA; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston Salem, NC, USA. Electronic address: esoliman@wakehealth.edu.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000378:metabolism; D004562:Electrocardiography; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D019380:Anti-HIV Agents; D002097:C-Reactive Protein
keywords: Cardiovascular disease; Electrocardiogram; HIV/AIDS; Spatial QRS-T angle