TY - JOUR

T1 - Presence of the metabolic syndrome (MS) is not a better predictor of cardiovascular disease (CVD) than the sum of its components in HIV-infected individuals. Data Collection on Adverse Events of Anti-HIV Drugs (The D:A:D study)

AU - Worm, Signe W

AU - Sabin, Caroline A

AU - Reiss, Peter

AU - El-Sadr, Wafaa

AU - Monforte, Antonella d'Arminio

AU - Pradier, Christian

AU - Thiebaut, Rodolphe

AU - Law, Matthew

AU - Rickenback, Martin

AU - Stephane, De Wit

AU - Lundgren, Jens

AU - Møller, Nina Friis

PY - 2009

Y1 - 2009

N2 - Objectives: It is much debated whether the MS contributes additional information over and above that provided by the individual components of the syndrome alone. Amongst HIV-infected individuals, we investigated whether any particular combinations of the components of the MS definition are associated with a higher risk of CVD. Research Design and Methods: We followed 33,347 HIV-infected individuals in a prospective observational study. The effect of combinations of components of the MS (low HDL cholesterol, high triglycerides, high BMI, hypertension and diabetes mellitus) on the risk CVD was assessed by Poisson regression incorporating interactions between each component pair and adjusting for age, sex, family history of CVD, smoking status, calendar year and exposure to antiretroviral therapy. We reduced the risk of type 1 errors by randomly splitting the dataset for training (70% of sample) and validation (remaining 30%). Results: In the training dataset, 671 patients experienced a CVD event over 110,652 person-years. Unadjusted, MS at study enrolment (>/=3 of the factors) was associated with a 2.89 higher risk of CVD (95% confidence interval [CI] 2.34, 3.59; p=0.0001) compared with individuals without the MS. After adjustment for the individual components, the MS as an entity no longer predicted the risk of CVD (adjusted relative risk 0.85; 95% CI 0.61, 1.17; p=0.32). No significant positive interactions were found between the components of the MS. Conclusions: The presence of the MS in HIV-infected individuals did not appear to increase the CVD risk over and above that conferred by the components of the syndrome separately.

AB - Objectives: It is much debated whether the MS contributes additional information over and above that provided by the individual components of the syndrome alone. Amongst HIV-infected individuals, we investigated whether any particular combinations of the components of the MS definition are associated with a higher risk of CVD. Research Design and Methods: We followed 33,347 HIV-infected individuals in a prospective observational study. The effect of combinations of components of the MS (low HDL cholesterol, high triglycerides, high BMI, hypertension and diabetes mellitus) on the risk CVD was assessed by Poisson regression incorporating interactions between each component pair and adjusting for age, sex, family history of CVD, smoking status, calendar year and exposure to antiretroviral therapy. We reduced the risk of type 1 errors by randomly splitting the dataset for training (70% of sample) and validation (remaining 30%). Results: In the training dataset, 671 patients experienced a CVD event over 110,652 person-years. Unadjusted, MS at study enrolment (>/=3 of the factors) was associated with a 2.89 higher risk of CVD (95% confidence interval [CI] 2.34, 3.59; p=0.0001) compared with individuals without the MS. After adjustment for the individual components, the MS as an entity no longer predicted the risk of CVD (adjusted relative risk 0.85; 95% CI 0.61, 1.17; p=0.32). No significant positive interactions were found between the components of the MS. Conclusions: The presence of the MS in HIV-infected individuals did not appear to increase the CVD risk over and above that conferred by the components of the syndrome separately.

U2 - 10.2337/dc08-1394

DO - 10.2337/dc08-1394

M3 - Journal article

C2 - 19056612

VL - 32

JO - Diabetes Care

JF - Diabetes Care

SN - 0149-5992

IS - 3

ER -