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Small Dense Lipoproteins, Apolipoprotein B, and Risk of Coronary Events in HIV-Infected Patients on Antiretroviral Therapy: The Swiss HIV Cohort Study

Bucher, Heiner C. MD, MPH*,†; Richter, Werner MD; Glass, Tracy R. PhD*; Magenta, Lorenzo MD§; Wang, Qing PhD*; Cavassini, Matthias MD; Vernazza, Pietro MD; Hirschel, Bernard MD#; Weber, Rainer MD**; Furrer, Hansjakob MD††; Battegay, Manuel MD; Bernasconi, Enos MD§

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1st, 2012 - Volume 60 - Issue 2 - p 135–142
doi: 10.1097/QAI.0b013e31824476e1
Clinical Science

Objectives: HIV infection and exposure to certain antiretroviral drugs is associated with dyslipidemia and increased risk for coronary events. Whether this risk is mediated by highly atherogenic lipoproteins is unclear. We investigated the association of highly atherogenic small dense low-density lipoproteins (LDLs) and apolipoprotein B and coronary events in HIV-infected individuals receiving antiretroviral therapy.

Methods: We conducted a case–control study nested into the Swiss HIV Cohort Study to investigate the association of small dense LDL and apolipoprotein B and coronary events in 98 antiretroviral drug–treated patients with a first coronary event (19 fatal and 79 nonfatal coronary events with 53 definite and 15 possible myocardial infarctions, 11 angioplasties or bypasses) and 393 treated controls matched for age, gender, and smoking status. Lipids were measured by ultracentrifugation.

Results: In models including cholesterol, triglycerides, high-density lipoprotein cholesterol, blood pressure, central obesity, diabetes, and family history, there was an independent association between small dense LDL and coronary events [odds ratio (OR) for 1 mg/dL increase: 1.06, 95% confidence interval (CI): 1.00 to 1.11] and apolipoprotein B (OR for 10 mg/dL increase: 1.16, 95% CI: 1.02 to 1.32). When adding HIV and antiretroviral therapy–related variables, ORs were 1.04 (95% CI: 0.99 to 1.10) for small dense LDL and 1.13 (95% CI: 0.99 to 1.30) for apolipoprotein B. In both models, blood pressure and HIV viral load was independently associated with the odds for coronary events.

Conclusions: HIV-infected patients receiving antiretroviral therapy with elevate small dense LDL and apolipoprotein B are at increased risk for coronary events as are patients without sustained HIV suppression.

*Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland

Institute for Lipid Metabolism, Munich, Germany

§Regional Hospital of Lugano, Lugano, Switzerland

Division of Infectious Diseases, University Hospital Lausanne, Lausanne, Switzerland

Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Switzerland

#Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland

**Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland

††Division of Infectious Diseases, University Hospital Bern and University of Bern, Bern, Switzerland

Correspondence to: Heiner C. Bucher, MD, MPH, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, CH-4031 Basel, Switzerland (e-mail: hbucher@uhbs.ch).

Supported by grants from Santésuisse and the Gottfried and Julia Bangerter-Rhyner-Foundation. Funded through a study grant of the Swiss HIV Cohort Study. The Swiss HIV Cohort Study is supported by the Swiss National Science Foundation, grant number 33CSC0-108787.

H.C.B. has received travel grants, honoraria, and unrestricted research grants from various pharmaceutical companies including, GlaxoSmithKline, Bristol-Myers-Squibb, Gilead, Janssen, Roche, Abbott, Tibotec, Boehringer-Ingelheim, and viiv Healtcare. M.B. has received travel grants, honoraria, and unrestricted educational and/or research grants from Abbott, Boehringer-Ingelheim, Gilead, MSD, Tibotec-Janssen, and ViiV Healtcare. Lorenzo Magenta has received travel grants and honoraria from Abbott, BMS, GlaxoSmithKline, Bristol-Myers-Squibb, Gilead, Tibotec-Janssen, Roche, Boehringer-Ingelheim, and ViiV Healtcare. The institution employing Hansjakob Furrer has received payments for participation in advisory boards and/or unrestricted educational grants from Abbott, BMS, ViiV Healthcare, Roche, Gilead, MSD, Boehringer-Ingelheim, Tibotec-Janssen, and ViiV Healthcare and research support from Gilead, MSD, and Roche. P.V. has received travel grants, honoraria, and unrestricted research grants from various pharmaceutical companies including, GlaxoSmithKline, Bristol-Myers-Squibb, Gilead, Janssen, Roche, Abbott, Tibotec, Boehringer-Ingelheim, and viiv Healtcare.

The funding organizations and sponsor had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the article.

Received September 21, 2011

Accepted November 30, 2011

© 2012 Lippincott Williams & Wilkins, Inc.