ObjectivesTo study the relationship between exposure to protease inhibitor (PI) therapy and increased risk of cardiovascular events in HIV-infected patients. MethodsWe estimated the risk of cardiovascular disease (CVD) events with PI exposure in a cohort of HIVinfected patients using a time-dependent Cox proportional hazards model adjusting for the major CVD risk factors. Only the first CVD event for each subject was counted. ResultsOf a total of 7542 patients, 77% were exposed to PIs. CVD event rates were 9.8/1000 and 6.5/1000 person-years of follow-up (PYFU) in the PI-exposed and nonexposed groups, respectively (P 5 0.0008). PI exposure 60 days was associated with an increased risk of CVD event [adjusted hazards ratio (HR adj ) 1.71; 95% confidence interval (CI) 1.08-2.74; P 5 0.03]. Results from a subgroup of patients aged between 35 and 65 years were similar (HR adj 1.90; 95% CI 1.13-3.20; P 5 0.02). Other significant risk factors included smoking status, age, hypertension, diabetes mellitus and pre-existing CVD. ConclusionsPatients exposed to PI therapy had an increased risk of CVD events. Clinicians should evaluate the risk of CVD when making treatment decisions for HIV-infected patients.Keywords: antiretroviral therapy, cardiovascular disease, HAART, protease inhibitors, treatment complications IntroductionHighly active antiretroviral therapy (HAART) has resulted in dramatic declines in progression to AIDS and AIDS mortality in HIV-infected persons [1][2][3][4][5][6]. In some reports, death from nonAIDS-related causes exceed those attributed to AIDS in this patient population [2,[7][8][9], and cardiovascular deaths are increasing in these patients [1,2]. Recent reports suggest a shift in the relative cause of death among HIV-infected individuals, with cardiovascular deaths accounting for fewer than 4% of all deaths pre-1997 [1,10], and for 7-10% in more recent years [8,10,11].Reports from large observational studies demonstrate that considerable controversy exists over the association of HAART, particularly protease inhibitor (PI) therapies, with increased cardiovascular disease (CVD) risk [12][13][14][15][16][17]. PIs have been associated with alterations in surrogate markers of CVD, including coronary calcium scores and endothelial function [18,19], as well as with metabolic complications such as hyperlipidaemia, fat redistribution, insulin resistance, hypertension and diabetes mellitus [19][20][21][22][23][24]. Also, HIV-infected patients may have a higher prevalence of traditional CVD risk factors such as smoking than the general population [20,21]. In addition, as the mean age of the HIV-infected patient population has increased as a result of longer life expectancy with the disease, the consequent cardiovascular risk has also increased. 37These changes in patient demographics and the increasing prevalence of traditional CVD risk factors such as smoking, along with the increasing prevalence of PIassociated metabolic complications, have clearly increased the risk of CVD in HIV-infected individuals. ...

The value of improved health in the US population in 2000 compared with 1980 significantly outweighs the additional health-care expenditures in 2000 compared with 1980.

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OBJECTIVES. The Nutrition Labeling and Education Act of 1990 mandates the Food and Drug Administration to promulgate changes in nutrition labeling regulations. This study investigates the potential health benefits associated with expected changes in food consumption resulting from the act. METHODS. This paper provides four estimates of the potential health benefits from the dietary changes expected to occur as a result of the 1990 act. The upper bound estimates begin with the premise that all consumers will adopt the daily reference values of total fat, saturated fat, and cholesterol. The lower bound estimate is based on consumers' responses to a shelf-labeling program sponsored by the Food and Drug Administration in the 1980s. A computer model developed by Dr. Warren Browner and his associates was used to estimate the health benefits from reduced nutrient intakes. RESULTS. Estimates of the number of discounted life-years gained nationwide for the first 20 years after the implementation of the act range from a high of 1.2 million to a low of 40,000. CONCLUSIONS. The results of the study highlight that relatively small changes in nutrient intakes may generate large public health benefits.

Both types of evaluation provide important information when a new treatment is introduced to a population.