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  1. Issues and Life Science, 2nd Edition
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Cardiovascular Disease Overview

MA Weber, ed. EK Chung. Cambridge, MA: Blackwell Science; Not Available. Citations Citation. Published: Ann Intern Med. DOI: Sign in below to access your subscription for full content.

Issues and Life Science, 2nd Edition

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Create Your Free Account Why? To receive access to the full text of freely available articles, alerts, and more. Higher metabolic changes were observed in patients with longer treatment time. It is concluded that preventive measures, as well as early treatment, can contribute to minimize the risks of developing cardiovascular diseases.

Key words: Acquired immunodeficiency syndrome; Survival; Highly active antiretroviral therapy; Cardiovascular risk factor. In , there were 2,, cases of new HIV infections worldwide, with a total of In Brazil, in , there were about , people living with HIV, with an estimated prevalence between 0. The proportional distribution of AIDS cases in Brazil by region shows a concentration of cases in the Southeast and South regions, corresponding to Regarding the regions, the North has an average of 3, cases per year; the Northeast, 7,; Southeast, 17,; South, 8,; and the Midwest, 2, 2.

In , the proportional distribution of 12, deaths was As a result of this policy that provided an opportunity to universal access to treatment, there has been a sharp drop in mortality rates associated with AIDS. Brazil currently has the largest antiretroviral treatment ART coverage among low and middle income countries, in which nearly half of individuals living with HIV have received ART 1. Highly active antiretroviral therapy HAART in patients with acquired immunodeficiency syndrome is associated with metabolic disorders such as dyslipidemia, insulin resistance, diabetes and visceral obesity, risk factors related to early atherosclerosis 3 , 4.

Kamin and Grinspoon 5 described metabolic disorders in a high proportion of patients treated with HAART regimens as well as increased risk of cardiovascular disease coronary artery disease and cerebrovascular accident — CVA , especially in those who receive treatment with protease inhibitors PIs. Ximenes et al.

With the use of combined antiretroviral therapy there has been increase in life expectancy of patients associated with the reduction of opportunistic infections; however, this population has been susceptible to chronic diseases and conditions related to risk factors common to the general population, mainly cardiovascular changes related to the adverse effects of antiretroviral drugs 9. Data were collected based on medical records and health problems reporting forms.

Medical records of patients with previous alterations in metabolic parameters of interest were excluded. This procedure aimed to observe the influence of the drug regimen on the metabolic profile of the patients, thus totaling medical records that were included in the study. The information was collected at a time interval of six months. The reference values used to classify dyslipidemias were those recommended by the V Brazilian Guideline on Dyslipidemias and Prevention of Atherosclerosis For the classification of blood pressure levels, the VII Brazilian Guideline on Hypertension was used as reference For glycemia classification, the parameters established by the Brazilian Society of Diabetes were followed CD4 count, viral load and treatment regimen were also checked.

In order to verify the factors influencing the change in blood pressure, cholesterol, HDL cholesterol, triglyceride and glycemia over time, the Marginal Logistic Regression was used. The marginal models, also known by GEE Generalized Equations Estimating method 13 , can be considered an extension of Generalized Linear Models 14 , which allow incorporating the expected correlation between the measurements performed in the same individual.

Marginal Regressions, for their ease in interpretation and absence of distributional assumptions, have been preferred as an extension of Generalized Linear Models for dependent data In order to select the variables gender, race, schooling, marital status, mode of transmission, sexual behavior, regimen, age at diagnosis and weight that could explain the occurrence of cardiovascular disease, researchers used the Stepwise method The Stepwise method is defined as a mixture of Backward and Forward methods, in which in the Forward method variables entry criterion a univariate analysis was performed by using the regression adjustment for each variable together with the variable time.

Also, the interactions of all variables were tested with time, since as this is a longitudinal study, this type of interaction is expected to happen. The selected variables and interactions were entered into a multivariate logistic marginal regression, and at this stage the Backward method was applied. The Backward method is the procedure to remove, at a time, the highest p-value variable, and this procedure is repeated until the only significant variables remain in the model. It is noteworthy that when the presence of interactions with time was verified, authors decided to perform comparisons fixing times 0,, 2, and 5,, which correspond to the first, second and third quartile, respectively.

The R software was used in the analyzes version 3. The follow-up time was The observed gender ratio was 1. Of the individuals surveyed, Only 3. Table 1 shows the description of qualitative variables in terms of time. From this, one can note that: on average and over the study period, the percentage of patients with Regimen C was On average and over the study period, the percentage of abnormal blood pressure was Regarding the size of the sample, it is also noteworthy that: the scheme showed 6, measurements relating to patients.

Therefore, on average, there were Blood pressure had 4, measurements concerning patients. Therefore, on average, there were 8. Cholesterol had measurements related to patients. Therefore, on average, there were 2. HDL cholesterol had measurements related to patients.


LDL cholesterol had measurements relating to patients, on average, there were 1. Triglycerides had measurements concerning patients on average, 2. Blood glucose had measures relating to patients 2. Table 2 shows the description of the quantitative variables time between first and last visit, diagnosis time, age at the first visit, average time between the first and last visit and age at diagnosis. From this, it can be noted that: the average time between the first and last visit was 5. The mean time between diagnosis and the last visit was 5.

The mean age at the first visit was The mean age at diagnosis was The average incidence rate was The average incidence rate observed for altered LDL was There was an average incidence rate of As for the blood glucose, the average incidence rate was Table 3 shows the comparison of the regimen between the categories of variables. In all regimens there was a higher percentage of patients with normal cholesterol and HDL cholesterol, with the exception of regimen A, which had a higher percentage of patients with altered parameters.

In untreated regimens, B and C there was a higher percentage of patients with normal LDL cholesterol. In untreated regimens, C and D, there was a higher percentage of patients with normal triglyceride levels, while in the regimens A and B there was a higher percentage of patients with altered triglycerides.

JMIR Publications

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