INTERNE GENEESKUNDE Hypertriglyceridemia, Metabolic Syndrome, and Cardiovascular Disease in HIV-infected patients: effects of antiretroviral therapy and adipose tissue distribution. Van Wijk JPH, Castro Cabezas M. Int J Vasc Med 2012; 2012: 201027 Epub. PMID: 21876813. The use of combination antiretroviral therapy (CART) in HIV-infected patients has resulted in a dramatic decline in AIDS-related mortality. However, mortality due to non-AIDS conditions, particularly cardiovascular disease (CVD) seems to increase in this population. CART has been associated with several metabolic risk factors, including insulin resistance, low HDL-cholesterol, hypertriglyceridemia and postprandial hyperlipidemia. In addition, HIV itself, as well as specific antiretroviral agents, may further increase cardiovascular risk by interfering with endothelial function. As the HIV population is aging, CVD may become an increasingly growing health problem in the future. Therefore, early diagnosis and treatment of cardiovascular risk factors is warranted in this population. This paper reviews the contribution of both, HIV infection and CART, to insulin resistance, postprandial hyperlipidemia and cardiovascular risk in HIV-infected patients. Strategies to reduce cardiovascular risk are also discussed. Exploring the value of apoB48 as a marker for atherosclerosis in clinical practice. Alipour A, Valdivielso P, Elte JWF, Janssen JW, Rioja J, van der Meulen N, van Mechelen R, Njo TL, González-Santos P, Rietveld AP, Castro Cabezas M. Eur J Clin Invest. 2012 Jul;42(7):702-8. PMID :22224712. BACKGROUND: Postprandial accumulation of atherogenic remnants has been described in patients with type 2 diabetes mellitus (T2DM), familial combined hyperlipidaemia (FCH), familial hypercholesterolaemia (FH) and coronary artery disease (CAD). Scarce data are available on fasting plasma apolipoprotein (apo) B48 levels in relation to these conditions and atherosclerosis. DESIGN: Treated patients with FCH (18), FH (20), T2DM (26), CAD (65), T2DM with CAD (T2DM/ CAD) (28) and 33 healthy controls were included. Intima-media thickness (IMT) measurements were carried out to investigate subclinical atherosclerosis. RESULTS: LDL-C and total apoB were lowest in patients with T2DM/CAD owing to the more frequent use of lipid-lowering medication. Fasting plasma apoB48 was mg/L) and T2DM/CAD 1·50 ± elevated in patients with FCH (11·38 mg/L) compared with the other groups (anova, P 1·14 ± (9·65<0·01). CAD mg/L) had higher apoB48 levels than controls 0·57 ± patients (8·09 0·02). IMT was = mg/L) (P 0·51 ± mg/L) and FH patients (5·40 0·55 ± (5·74 mm) (P 0·03 ± highest in subjects with T2DM/CAD (0·77<0·01). The lowest IMT mm). In 0·03 ± mm) and FCH patients (0·60 0·02 ± was measured in controls (0·56 the total group, the best association for apoB48 was found with fasting 0·72, P = triglyceride (Pearson’s r<0·001). In the subjects not using 0·52; = 74), the best correlation was found with IMT (r = statins (n P<0·20, = 0·001), whereas total apoB was not associated with IMT (r 0·12). = P CONCLUSIONS: ApoB48 concentrations are highest in patients with FCH and in atherosclerotic subjects with T2DM. In patients not using statins, the surrogate atherosclerosis marker IMT correlates best with apoB48, suggesting that fasting apoB48 may help to detect subjects at risk. 40 WETENSCHAPPELIJK jaarverslag 2012 Pagina 39
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