Class of Antiretroviral Drugs and the Risk of Myocardial Infarction
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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Class of Antiretroviral Drugs and the Risk of Myocardial Infarction. / Friis-Møller, Nina; Reiss, P.; Sabin, C.A.; Weber, R.; Monforte, A.D.; Sadr, W. El; Wit, S. De; Kirk, Ole; Fontas, E.; Law, M.G.; Phillips, A.; Lundgren, Jens Dilling; Friis-Møller, Nina; Reiss, P; Sabin, CA; Weber, R; D'Arminio Monforte, A; El-Sadr, W; Thiebault, R; de Wit, S; Kirk, Ole; Fontas, E; Law, MG; Phillips, A; Lundgren, Jens Dilling.
I: New England Journal of Medicine, Bind 356, Nr. 17, 2007, s. 1723-35.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Class of Antiretroviral Drugs and the Risk of Myocardial Infarction
AU - Friis-Møller, Nina
AU - Reiss, P.
AU - Sabin, C.A.
AU - Weber, R.
AU - Monforte, A.D.
AU - Sadr, W. El
AU - Wit, S. De
AU - Kirk, Ole
AU - Fontas, E.
AU - Law, M.G.
AU - Phillips, A.
AU - Lundgren, Jens Dilling
AU - Friis-Møller, Nina
AU - Reiss, P
AU - Sabin, CA
AU - Weber, R
AU - D'Arminio Monforte, A
AU - El-Sadr, W
AU - Thiebault, R
AU - de Wit, S
AU - Kirk, Ole
AU - Fontas, E
AU - Law, MG
AU - Phillips, A
AU - Lundgren, Jens Dilling
N1 - Copyright 2007 Massachusetts Medical Society.
PY - 2007
Y1 - 2007
N2 - BACKGROUND: We have previously demonstrated an association between combination antiretroviral therapy and the risk of myocardial infarction. It is not clear whether this association differs according to the class of antiretroviral drugs. We conducted a study to investigate the association of cumulative exposure to protease inhibitors and nonnucleoside reverse-transcriptase inhibitors with the risk of myocardial infarction. METHODS: We analyzed data collected through February 2005 from our prospective observational study of 23,437 patients infected with the human immunodeficiency virus. The incidence rates of myocardial infarction during the follow-up period were calculated, and the associations between myocardial infarction and exposure to protease inhibitors or nonnucleoside reverse-transcriptase inhibitors were determined. RESULTS: Three hundred forty-five patients had a myocardial infarction during 94,469 person-years of observation. The incidence of myocardial infarction increased from 1.53 per 1000 person-years in those not exposed to protease inhibitors to 6.01 per 1000 person-years in those exposed to protease inhibitors for more than 6 years. After adjustment for exposure to the other drug class and established cardiovascular risk factors (excluding lipid levels), the relative rate of myocardial infarction per year of protease-inhibitor exposure was 1.16 (95% confidence interval [CI], 1.10 to 1.23), whereas the relative rate per year of exposure to nonnucleoside reverse-transcriptase inhibitors was 1.05 (95% CI, 0.98 to 1.13). Adjustment for serum lipid levels further reduced the effect of exposure to each drug class to 1.10 (95% CI, 1.04 to 1.18) and 1.00 (95% CI, 0.93 to 1.09), respectively. CONCLUSIONS: Increased exposure to protease inhibitors is associated with an increased risk of myocardial infarction, which is partly explained by dyslipidemia. We found no evidence of such an association for nonnucleoside reverse-transcriptase inhibitors; however, the number of person-years of observation for exposure to this class of drug was less than that for exposure to protease inhibitors. Copyright 2007 Massachusetts Medical Society. Comment in: N Engl J Med. 2007 Apr 26;356(17):1705-7. N Engl J Med. 2007 Apr 26;356(17):1773-5. N Engl J Med. 2007 Aug 16;357(7):715-6; author reply 716-7. N Engl J Med. 2007 Aug 16;357(7):715; author reply 716-7. N Engl J Med. 2007 Aug 16;357(7):716; author reply 716-7.
AB - BACKGROUND: We have previously demonstrated an association between combination antiretroviral therapy and the risk of myocardial infarction. It is not clear whether this association differs according to the class of antiretroviral drugs. We conducted a study to investigate the association of cumulative exposure to protease inhibitors and nonnucleoside reverse-transcriptase inhibitors with the risk of myocardial infarction. METHODS: We analyzed data collected through February 2005 from our prospective observational study of 23,437 patients infected with the human immunodeficiency virus. The incidence rates of myocardial infarction during the follow-up period were calculated, and the associations between myocardial infarction and exposure to protease inhibitors or nonnucleoside reverse-transcriptase inhibitors were determined. RESULTS: Three hundred forty-five patients had a myocardial infarction during 94,469 person-years of observation. The incidence of myocardial infarction increased from 1.53 per 1000 person-years in those not exposed to protease inhibitors to 6.01 per 1000 person-years in those exposed to protease inhibitors for more than 6 years. After adjustment for exposure to the other drug class and established cardiovascular risk factors (excluding lipid levels), the relative rate of myocardial infarction per year of protease-inhibitor exposure was 1.16 (95% confidence interval [CI], 1.10 to 1.23), whereas the relative rate per year of exposure to nonnucleoside reverse-transcriptase inhibitors was 1.05 (95% CI, 0.98 to 1.13). Adjustment for serum lipid levels further reduced the effect of exposure to each drug class to 1.10 (95% CI, 1.04 to 1.18) and 1.00 (95% CI, 0.93 to 1.09), respectively. CONCLUSIONS: Increased exposure to protease inhibitors is associated with an increased risk of myocardial infarction, which is partly explained by dyslipidemia. We found no evidence of such an association for nonnucleoside reverse-transcriptase inhibitors; however, the number of person-years of observation for exposure to this class of drug was less than that for exposure to protease inhibitors. Copyright 2007 Massachusetts Medical Society. Comment in: N Engl J Med. 2007 Apr 26;356(17):1705-7. N Engl J Med. 2007 Apr 26;356(17):1773-5. N Engl J Med. 2007 Aug 16;357(7):715-6; author reply 716-7. N Engl J Med. 2007 Aug 16;357(7):715; author reply 716-7. N Engl J Med. 2007 Aug 16;357(7):716; author reply 716-7.
KW - Adult
KW - Anti-Retroviral Agents
KW - Dyslipidemias
KW - Female
KW - Follow-Up Studies
KW - HIV Infections
KW - HIV Protease Inhibitors
KW - HIV-1
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Myocardial Infarction
KW - Observation
KW - Poisson Distribution
KW - Prospective Studies
KW - Reverse Transcriptase Inhibitors
KW - Risk
U2 - 10.1056/NEJMoa062744
DO - 10.1056/NEJMoa062744
M3 - Journal article
C2 - 17460226
VL - 356
SP - 1723
EP - 1735
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 17
ER -
ID: 4035052