Metabolic Syndrome in Older HIV-Infected Patients: Data from the CORE50 Cohort

Abstract

Metabolic abnormalities and cardiovascular disease are increasingly recognized in HIV-infected patients. While HIV-infected patients older than 50 years of age account for up to 25% of HIV cases in the United States, there are limited data on these individuals. To determine the prevalence and predictors of the metabolic syndrome among a cohort of older, HIV-infected patients and to calculate their 10-year Framingham cardiac risk (FCR) score a cross-sectional study of HIV patients older than 50 years of age was conducted at the CORE Center, Chicago, Illinois, between May 2005 and February 2006. There were 121 HIV-infected patients with a median age of 54 years, of whom 79% were male, 83% African American, 9% Hispanic, and 6% Caucasian. Thirty-four percent of patients had the metabolic syndrome, 49% had a moderate-high (>10%) 10-year FCR, and 13% had a high (>20%) 10-year FCR. Patients with the metabolic syndrome were significantly more likely to have a greater than 20% 10-year FCR. Sixty-five percent of all patients were current smokers and 55% of patients with the metabolic syndrome were current smokers. There were significant differences in the components of the metabolic syndrome by gender with women having significantly more components related to insulin resistance such as elevated waist circumference and diabetes, while men were more likely to have low high-density lipoprotein (HDL) levels. This study shows a high prevalence of the metabolic syndrome in older HIV-infected patients and an association between the metabolic syndrome and FCR in our study population. As the HIV population ages, attention to modifiable cardiac risk factors will become increasingly important.

Association of Age and Comorbidity with Physical Function in HIV-Infected and Uninfected Patients: Results from the Veterans Aging Cohort Study

“…Given that HIV-infected patients may have increased risk of coronary heart disease and cardiac dysfunction, 1,3,29 CVD will likely become a significant source of physical disability in HIV-infected patients who are otherwise stable on cART, and thus provides additional incentive to reduce cardiac risk factors. 4 Although none of the CVD conditions in our study were associated with worse function in HIV-infected patients compared to uninfected patients, our function scale may be unable to distinguish these differences given the scale's ceiling effect. In addition, self-report in general may be limited in its capacity to measure specific functional performance parameters, such as endurance, which are related to cardiovascular disease.…”

“…vidence for increased risk of age-associated conditions in HIV-infected patients, including coronary artery disease and cardiovascular risk factors, [1][2][3][4] chronic pulmonary disease, [5][6][7] low bone mineral density, 8 and frailty 9 supports the concern that chronic HIV infection and prolonged antiretroviral therapy might be associated with an accelerated aging process. 2,5,7,10,11 In adults without HIV, history of these age-associated conditions is an independent risk factor for decline in physical function with aging.…”

The Hemostatic Balance in HIV-Infected Patients with and without Antiretroviral Therapy: Partial Restoration with Antiretroviral Therapy

“…[11][12][13][14][15][16] The metabolic syndrome has a reported prevalence of 17%-27% in HIV-infected patients with a median age of 40-45 years and even reaches 35% in HIV-infected patients aged 50 or older. 17 Cigarette smoking is a common modifiable risk factor. 17 Since AT and VTE are potentially fatal complications of HIV infection, a better insight is needed into the pathogenesis to identify patients at greatest risk for whom antithrombotic prophylaxis may be warranted.…”

“…17 Cigarette smoking is a common modifiable risk factor. 17 Since AT and VTE are potentially fatal complications of HIV infection, a better insight is needed into the pathogenesis to identify patients at greatest risk for whom antithrombotic prophylaxis may be warranted. Earlier, mostly retrospective, studies with a small number of patients focused on a selection of coagulation and fibrinolytic markers.…”

Relationships Among HIV Infection, Metabolic Risk Factors, and Left Ventricular Structure and Function

“…1). 31 Most of the prior research examined the prevalence of the metabolic syndrome in HIV + individuals using the traditional ATP-III criteria of impaired fasting glucose [32][33][34][35] ; however, others have used additional criteria 36,37 to define impaired fasting glucose. We included fasting insulin as a criterion for abnormal glucose metabolism because HIV infection is associated with fasting hyperinsulinemia but normal glycemia, while typical metabolic syndrome (HIV -) is associated with fasting hyperinsulinemia and hyperglycemia.…”