title: Randomized trial of a multidisciplinary lifestyle intervention in HIV-infected patients with moderate-high cardiovascular risk.
abstract: OBJECTIVE
  To assess the impact of a multidisciplinary lifestyle intervention on cardiovascular risk and carotid intima-media thickness (c-IMT) in HIV-infected patients with Framingham scores (FS) > 10%.
  
  
  METHODS
  Randomized pilot study; follow-up 36 months.
  
  
  METHODS
  Virologically suppressed adult HIV-1-infected patients with FS >10% were randomized 1:1 to the intervention group (multidisciplinary lifestyle intervention) or control group (routine care). At baseline and months 12, 24 and 36, lipid parameters were analyzed and carotid ultrasound was performed to determine c-IMT and presence of plaques. Biomarkers were measured at baseline and month 36. The primary endpoints were lipid and FS changes at 36 months.
  
  
  RESULTS
  Fifty-four patients were included, 27 in each arm. Median age was 50.5 years, all patients but one were men, and FS was 16.5%. Relative to controls, total and LDL cholesterol had significantly decreased in the intervention group at 24 months (p = 0.039, p = 0.011, respectively). However, no differences between groups were found at month 36 in lipid variables, neither in FS. Tobacco use decreased in the intervention group (p = 0.031). At baseline, 74.5% of patients had subclinical atherosclerosis, and at month 36, we observed a progression in c-IMT that was greater in the intervention group (p = 0.030). D-dimer increased (p = 0.027) and soluble intercellular adhesion molecule-1 decreased (p = 0.018) at 36 months.
  
  
  CONCLUSIONS
  In this cohort of HIV-infected patients with FS>10% and a high percentage of subclinical atherosclerosis, a multidisciplinary lifestyle intervention resulted in a slight improvement in some cardiovascular risk factors and the FS during the first 2 years, but did not prevent c-IMT progression.
authors.affiliation: HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain. Electronic address: msaumoy@bellvitgehospital.cat.
authors.forename: Maria
authors.initials: M
authors.lastname: Saumoy
authors.affiliation: Unitat Clínica CS Llevant, Hospital Santa Tecla, Tarragona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Alonso-Villaverde
authors.affiliation: HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Navarro
authors.affiliation: HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Olmo
authors.affiliation: Vascular Surgery Service, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Vila
authors.affiliation: Preventive Medicine Service, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Ramon
authors.affiliation: HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain.
authors.forename: Silvana
authors.initials: S
authors.lastname: Di Yacovo
authors.affiliation: HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Ferrer
authors.affiliation: HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Curto
authors.affiliation: Department of Mechanical Engineering, Universitat Rovira i Virgili, Tarragona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vernet
authors.affiliation: HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Vila
authors.affiliation: HIV Unit, Infectious Disease Service, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Podzamczer
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D059168:Carotid Intima-Media Thickness; D004032:Diet / Q000009:adverse effects; D018450:Disease Progression; D015444:Exercise; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D058226:Plaque, Atherosclerotic; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016540:Smoking Cessation; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008055:Lipids
keywords: Biomarkers; Cardiovascular risk; Carotid intima-media thickness; Carotid plaques; Lifestyle intervention