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Increased risk of cardiovascular disease (CVD) with age in men: a comparison of the D:A:D CVD risk equation and general population CVD risk equations

Increased risk of cardiovascular disease (CVD) with age in men: a comparison of the D:A:D CVD risk equation and general population CVD risk equations

Background: It is unclear whether the risk of cardiovascular disease (CVD) is increasing more rapidly with age in HIV positive (HIV+) patients. We hypothesize that accelerated ageing in HIV+ patients would mean an accelerating risk of CVD with older age, and that the increased risk per year older would be higher in D:A:D relative to the general population. In this analysis we model the risk of CVD by age in D:A:D, and compare with the aging effects seen in conventional CVD risk equations.

Methods: We included all male D:A:D participants without prior CVD and with all conventional CVD risk factors available. We analysed three endpoints: myocardial infarction (MI), coronary heart disease (CHD: MI+invasive coronary procedure), and CVD (CVD: CHD+ stroke). We fitted a number of parametric age effects, adjusting for known risk factors and ART use. The best fitting age effect was determined using the Akaike Information Criteria. We compared the relative risk increase of CVD per year older from 40 years old in the D:A:D data to the general population risk equations – the Framingham Heart Study, CUORE and ASSIGN.

Results: 24,323 men were included in analyses, with median age 41 years at baseline. Crude MI, CHD and CVD event rates increased from 2.29, 3.11 and 3.65 in those aged 40-45 years to 6.53, 11.91 and 15.89 in those aged 60-65 years. In D:A:D there was a slowly accelerating risk of CHD and CVD per year older, which was somewhat raised compared to the general population based equations for CHD and CVD. The relative risk of MI with age was not different between D:A:D and the general population.

Conclusion: We found limited evidence of accelerating risk of CVD with age in D:A:D. The absolute risk of CVD associated with HIV infection remains unknown.

Conference: ASHM 2013

AIDS 2013

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