Diabetes mellitus, preexisting coronary heart disease, and the risk of subsequent coronary heart disease events in patients infected with human immunodeficiency virus: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D Study).

Description

This study sought to investigate the predictive value of pre-existing diabetes and coronary heart disease (CHD) for subsequent CHD events in patients (n=33,347) with the human immunodeficiency virus (HIV). In this large, prospective, international, observational study, the risk of CHD was 7.52 times higher in patients with pre-existing CHD compared to those with no prior CHD, while the risk of CHD was 2.41 times higher in patients with pre-existing diabetes mellitus compared to those without diabetes mellitus. Moreover, there was a significant interaction between pre-existing CHD and diabetes mellitus, suggesting that the CHD rate in those with both pre-existing CHD and diabetes mellitus was lower than expected on the basis of the main effects alone. Thus, both pre-existing diabetes mellitus and CHD are significant predictors for recurrent CHD in HIV-infected patients. Dr. Steven Grinspoon, who wrote the accompanying editorial, emphasized that the study by Worm et al. provided clear prospective data on the cardiovascular risk associated with diabetes in the HIV population. He also noted that a more aggressive approach needs to be taken in the screening of diabetes mellitus in the HIV population and in the development of targeted prevention and treatment strategies in order to save more lives in this population.