Severity of cardiovascular disease outcomes among patients with HIV is related to markers of inflammation and coagulation

Anna D Nordell; Matthew McKenna; Álvaro H Borges; Daniel Duprez; Jacqueline Neuhaus; James D Neaton; INSIGHT SMART, ESPRIT Study Groups

doi:10.1161/JAHA.114.000844

Severity of cardiovascular disease outcomes among patients with HIV is related to markers of inflammation and coagulation

Anna D Nordell, Matthew McKenna, Álvaro H Borges, Daniel Duprez, Jacqueline Neuhaus, James D Neaton, INSIGHT SMART, ESPRIT Study Groups

122 Citationer (Scopus)

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Abstract

BACKGROUND: In the general population, raised levels of inflammatory markers are stronger predictors of fatal than nonfatal cardiovascular disease (CVD) events. People with HIV have elevated levels of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and D-dimer; HIV-induced activation of inflammatory and coagulation pathways may be responsible for their greater risk of CVD. Whether the enhanced inflammation and coagulation associated with HIV is associated with more fatal CVD events has not been investigated.

METHODS AND RESULTS: Biomarkers were measured at baseline for 9764 patients with HIV and no history of CVD. Of these patients, we focus on the 288 that experienced either a fatal (n=74) or nonfatal (n=214) CVD event over a median of 5 years. Odds ratios (ORs) (fatal versus nonfatal CVD) (95% confidence intervals [CIs]) associated with a doubling of IL-6, D-dimer, hsCRP, and a 1-unit increase in an IL-6 and D-dimer score, measured a median of 2.6 years before the event, were 1.39 (1.07 to 1.79), 1.40 (1.10 to 1.78), 1.09 (0.93 to 1.28), and 1.51 (1.15 to 1.97), respectively. Of the 214 patients with nonfatal CVD, 23 died during follow-up. Hazard ratios (95% CI) for all-cause mortality were 1.72 (1.28 to 2.31), 1.73 (1.27 to 2.36), 1.44 (1.15 to 1.80), and 1.88 (1.39 to 2.55), respectively, for IL-6, D-dimer, hsCRP, and the IL-6 and D-dimer score.

CONCLUSIONS: Higher IL-6 and D-dimer levels reflecting enhanced inflammation and coagulation associated with HIV are associated with a greater risk of fatal CVD and a greater risk of death after a nonfatal CVD event.

CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrial.gov Unique identifier: SMART: NCT00027352, ESPRIT: NCT00004978, SILCAAT: NCT00013611.

Originalsprog	Engelsk
Artikelnummer	e000844
Tidsskrift	American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease
Vol/bind	3
Sider (fra-til)	1-10
Antal sider	10
ISSN	2047-9980
DOI	https://doi.org/10.1161/JAHA.114.000844
Status	Udgivet - jun. 2014

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10.1161/JAHA.114.000844Licens: CC BY-NC

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Nordell, A. D., McKenna, M., Borges, Á. H., Duprez, D., Neuhaus, J., Neaton, J. D., & INSIGHT SMART, ESPRIT Study Groups (2014). Severity of cardiovascular disease outcomes among patients with HIV is related to markers of inflammation and coagulation. American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease, 3, 1-10. [e000844]. https://doi.org/10.1161/JAHA.114.000844

Severity of cardiovascular disease outcomes among patients with HIV is related to markers of inflammation and coagulation. / Nordell, Anna D; McKenna, Matthew; Borges, Álvaro H et al.

I: American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease, Bind 3, e000844, 06.2014, s. 1-10.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Nordell, AD, McKenna, M, Borges, ÁH, Duprez, D, Neuhaus, J, Neaton, JD & INSIGHT SMART, ESPRIT Study Groups 2014, 'Severity of cardiovascular disease outcomes among patients with HIV is related to markers of inflammation and coagulation', American Heart Association. Journal. Cardiovascular and Cerebrovascular Disease, bind 3, e000844, s. 1-10. https://doi.org/10.1161/JAHA.114.000844

@article{dadaf9c73ee44834b3f70fb8234dfdba,

title = "Severity of cardiovascular disease outcomes among patients with HIV is related to markers of inflammation and coagulation",

abstract = "BACKGROUND: In the general population, raised levels of inflammatory markers are stronger predictors of fatal than nonfatal cardiovascular disease (CVD) events. People with HIV have elevated levels of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and D-dimer; HIV-induced activation of inflammatory and coagulation pathways may be responsible for their greater risk of CVD. Whether the enhanced inflammation and coagulation associated with HIV is associated with more fatal CVD events has not been investigated.METHODS AND RESULTS: Biomarkers were measured at baseline for 9764 patients with HIV and no history of CVD. Of these patients, we focus on the 288 that experienced either a fatal (n=74) or nonfatal (n=214) CVD event over a median of 5 years. Odds ratios (ORs) (fatal versus nonfatal CVD) (95% confidence intervals [CIs]) associated with a doubling of IL-6, D-dimer, hsCRP, and a 1-unit increase in an IL-6 and D-dimer score, measured a median of 2.6 years before the event, were 1.39 (1.07 to 1.79), 1.40 (1.10 to 1.78), 1.09 (0.93 to 1.28), and 1.51 (1.15 to 1.97), respectively. Of the 214 patients with nonfatal CVD, 23 died during follow-up. Hazard ratios (95% CI) for all-cause mortality were 1.72 (1.28 to 2.31), 1.73 (1.27 to 2.36), 1.44 (1.15 to 1.80), and 1.88 (1.39 to 2.55), respectively, for IL-6, D-dimer, hsCRP, and the IL-6 and D-dimer score.CONCLUSIONS: Higher IL-6 and D-dimer levels reflecting enhanced inflammation and coagulation associated with HIV are associated with a greater risk of fatal CVD and a greater risk of death after a nonfatal CVD event.CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrial.gov Unique identifier: SMART: NCT00027352, ESPRIT: NCT00004978, SILCAAT: NCT00013611.",

keywords = "Adult, Biological Markers, Blood Coagulation, C-Reactive Protein, Cardiovascular Diseases, Female, Fibrin Fibrinogen Degradation Products, HIV Infections, Humans, Inflammation, Interleukin-6, Male, Middle Aged, Odds Ratio",

author = "Nordell, {Anna D} and Matthew McKenna and Borges, {{\'A}lvaro H} and Daniel Duprez and Jacqueline Neuhaus and Neaton, {James D} and {INSIGHT SMART, ESPRIT Study Groups}",

note = "{\textcopyright} 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.",

year = "2014",

month = jun,

doi = "10.1161/JAHA.114.000844",

language = "English",

volume = "3",

pages = "1--10",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Severity of cardiovascular disease outcomes among patients with HIV is related to markers of inflammation and coagulation

AU - Nordell, Anna D

AU - McKenna, Matthew

AU - Borges, Álvaro H

AU - Duprez, Daniel

AU - Neuhaus, Jacqueline

AU - Neaton, James D

AU - INSIGHT SMART, ESPRIT Study Groups

PY - 2014/6

Y1 - 2014/6

N2 - BACKGROUND: In the general population, raised levels of inflammatory markers are stronger predictors of fatal than nonfatal cardiovascular disease (CVD) events. People with HIV have elevated levels of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and D-dimer; HIV-induced activation of inflammatory and coagulation pathways may be responsible for their greater risk of CVD. Whether the enhanced inflammation and coagulation associated with HIV is associated with more fatal CVD events has not been investigated.METHODS AND RESULTS: Biomarkers were measured at baseline for 9764 patients with HIV and no history of CVD. Of these patients, we focus on the 288 that experienced either a fatal (n=74) or nonfatal (n=214) CVD event over a median of 5 years. Odds ratios (ORs) (fatal versus nonfatal CVD) (95% confidence intervals [CIs]) associated with a doubling of IL-6, D-dimer, hsCRP, and a 1-unit increase in an IL-6 and D-dimer score, measured a median of 2.6 years before the event, were 1.39 (1.07 to 1.79), 1.40 (1.10 to 1.78), 1.09 (0.93 to 1.28), and 1.51 (1.15 to 1.97), respectively. Of the 214 patients with nonfatal CVD, 23 died during follow-up. Hazard ratios (95% CI) for all-cause mortality were 1.72 (1.28 to 2.31), 1.73 (1.27 to 2.36), 1.44 (1.15 to 1.80), and 1.88 (1.39 to 2.55), respectively, for IL-6, D-dimer, hsCRP, and the IL-6 and D-dimer score.CONCLUSIONS: Higher IL-6 and D-dimer levels reflecting enhanced inflammation and coagulation associated with HIV are associated with a greater risk of fatal CVD and a greater risk of death after a nonfatal CVD event.CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrial.gov Unique identifier: SMART: NCT00027352, ESPRIT: NCT00004978, SILCAAT: NCT00013611.

AB - BACKGROUND: In the general population, raised levels of inflammatory markers are stronger predictors of fatal than nonfatal cardiovascular disease (CVD) events. People with HIV have elevated levels of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and D-dimer; HIV-induced activation of inflammatory and coagulation pathways may be responsible for their greater risk of CVD. Whether the enhanced inflammation and coagulation associated with HIV is associated with more fatal CVD events has not been investigated.METHODS AND RESULTS: Biomarkers were measured at baseline for 9764 patients with HIV and no history of CVD. Of these patients, we focus on the 288 that experienced either a fatal (n=74) or nonfatal (n=214) CVD event over a median of 5 years. Odds ratios (ORs) (fatal versus nonfatal CVD) (95% confidence intervals [CIs]) associated with a doubling of IL-6, D-dimer, hsCRP, and a 1-unit increase in an IL-6 and D-dimer score, measured a median of 2.6 years before the event, were 1.39 (1.07 to 1.79), 1.40 (1.10 to 1.78), 1.09 (0.93 to 1.28), and 1.51 (1.15 to 1.97), respectively. Of the 214 patients with nonfatal CVD, 23 died during follow-up. Hazard ratios (95% CI) for all-cause mortality were 1.72 (1.28 to 2.31), 1.73 (1.27 to 2.36), 1.44 (1.15 to 1.80), and 1.88 (1.39 to 2.55), respectively, for IL-6, D-dimer, hsCRP, and the IL-6 and D-dimer score.CONCLUSIONS: Higher IL-6 and D-dimer levels reflecting enhanced inflammation and coagulation associated with HIV are associated with a greater risk of fatal CVD and a greater risk of death after a nonfatal CVD event.CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrial.gov Unique identifier: SMART: NCT00027352, ESPRIT: NCT00004978, SILCAAT: NCT00013611.

KW - Adult

KW - Biological Markers

KW - Blood Coagulation

KW - C-Reactive Protein

KW - Cardiovascular Diseases

KW - Female

KW - Fibrin Fibrinogen Degradation Products

KW - HIV Infections

KW - Humans

KW - Inflammation

KW - Interleukin-6

KW - Male

KW - Middle Aged

KW - Odds Ratio

U2 - 10.1161/JAHA.114.000844

DO - 10.1161/JAHA.114.000844

M3 - Journal article

C2 - 24870935

SN - 2047-9980

VL - 3

SP - 1

EP - 10

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

M1 - e000844

ER -

Severity of cardiovascular disease outcomes among patients with HIV is related to markers of inflammation and coagulation

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