Asymptomatic myocardial ischaemia in HIV-infected adults

Background: Asymptomatic ischaemic heart disease (IHD) in HIV-infected patients has not been studied. Methods: Resting, 12-lead electrocardiograms (ECG) were evaluated for asymptomatic IHD (Q-wave and/or ST segment depression) at baseline from HIV-infected participants with no known IHD enrolling in the SMART study. The ECG recordings were standardized and centrally analysed. Factors associated with asymptomatic IHD were identified by logistic regression, sequentially adjusted for demographics, clinical history, metabolic risk factors and type and duration of antiretroviral therapy (ART). Results: Of 4831 participants with an evaluable, baseline ECG and no prior IHD, mean age was 44 years (SD, 9.3); 28.4% were female; 6.6% had diabetes; 16.5% were receiving anti hypertensive therapy; and 95.4% were ART experienced. ECG evidence of IHD was detected in 526 (10.9%) [Q-wave in 283 (5.9%), ST segment depression in 264 (5.5%)]; 16.7% in those 60 years or older. Variables independently associated with these abnormalities were older age [age >= 60 versus < 40 years: odds ratio (OR), 2.2; 95% confidence interval (CI), 1.5-3.2; P < 0.001], current anti hypertensive therapy (OR, 1.5; 95% CI, 1.1-1.9; P=0.003) and recruitment in Europe (OR, 1.4; 95% Cl, 1.1-1.7; P=0.004) or Asia (OR, 1.6; 95% CI, 1.0-2.6; P=0.05), both compared with North America. Diabetes was borderline significant (OR, 1.4; 95% Cl, 1.0-2.0; P = 0.06). Conclusions: ECG evidence of asymptomatic IHD was common in this large cohort of HIV-infected adults and more common than a history of symptomatic IHD. Traditional factors were the predominant determinants of risk. No clear association between ART type or duration and asymptomatic IHD was noted. (c) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.