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HDL Particles but not LDL Particles Predict Cardiovascular Disease Events in HIV Patients: Results from Strategies for Management of ART Study (SMART). Daniel A Duprez, MD, PhD On behalf of the SMART/INSIGHT Group University of Minnesota. Background.
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HDL Particles but not LDL Particles Predict Cardiovascular Disease Events in HIV Patients:Results from Strategies for Management of ART Study (SMART)
Daniel A Duprez, MD, PhD
On behalf of the SMART/INSIGHT Group
University of Minnesota
In the SMART Study, intermittent ART compared to continuous ART was found to cause an excess risk of all-cause mortality and cardiovascular disease.
ART interruption is associated with a decline in HDL-and LDL-cholesterol.
Lower levels of HDL-cholesterol are associated with an increased risk of CVD.
Total Chol 205 mg/dL
Triglycerides 180 mg/dL
HDL-chol 36 mg/dL
LDL-chol 115 mg/dL
Small LDL-p 1100nmol/L
Large LDL-p 500nmol/L
Large HDL-p 8µmol/L
Small HDL-p 23µmol/L
28µmol/LSubjects with same HDL-cholesterol can have different HDL-particle concentrations
Segrest JP et al. Adv Protein Chem. 1994;45:303–369
Nuclear magnetic resonance (NMR) enables quantification of concentrations of lipid particles of varying size.
Data suggest that smaller LDL particle size, specifically a predominance of small dense LDL or a greater number of small LDL particles, is a predictor of coronary artery disease.
Studies of non-HIV-infected cohorts have also reported that HDL particle sizes are related to ischemic heart disease.
– Date of randomization (+/- 3 months)
Clinical MI, Silent MI, CABG, PCI, CAD requiring medical therapy
Stroke, Peripheral Arterial Disease
CVD or unwitnessed death
OR for CVD
In the SMART Trial lower total HDL-p and especially small HDL-p are predictive for cardiovascular events in HIV patients.
Intermittent ART therapy (DC) is associated with a decrease in HDL-p concentration in comparison with continuous therapy (VS) after one month.
The long-term effects of ART on HDL-chol and particles and therapy to increase it need to be further studied in randomized trials in HIV patients.