Effects of lifestyle modification and metformin on atherosclerotic indices among HIV-infected patients with the metabolic syndrome.

Kathleen Fitch, Suhny Abbara, Hang Lee, Eleni Stavrou, Rachel Sacks, Theresa Michel, Linda Hemphill, Martin Torriani, Steven Grinspoon

Research output: Contribution to journalArticle

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Abstract

Metabolic abnormalities including diabetes, dyslipidemia, hypertension, and abdominal obesity occur commonly in HIV patients, are associated with increased coronary artery calcification (CAC), and contribute to increased cardiovascular disease (CVD) in this population. We hypothesized that lifestyle modification (LSM) and metformin would improve CVD indices in HIV patients with metabolic syndrome. A randomized, placebo-controlled trial to investigate LSM and metformin, alone and in combination, over 1 year, among 50 HIV-infected patients with metabolic syndrome. We assessed CAC, cardiovascular and metabolic indices. Among the participants, duration of HIV-infection was 14 ± 1 year and duration of antiretroviral therapy was 6 ± 1 year. Metformin-treated patients demonstrated significantly less progression of CAC (-1 ± 2 vs. 33 ± 17, P = 0.004, metformin vs. placebo), whereas the effect of LSM on CAC progression was not significant (8 ± 6 vs. 21 ± 14, P = 0.82, LSM vs. no-LSM). Metformin had a significantly greater effect on CAC than LSM (P = 0.01). Metformin-treated patients also demonstrated less progression in calcified plaque volume (-0.4 ± 1.9 vs. 27.6 ± 13.8 μl, P = 0.008) and improved homeostatic model of assessment-insulin resistance (HOMA-IR) (P = 0.05) compared with placebo. Participants randomized to LSM vs. no-LSM showed significant improvement in HDL (P = 0.03), high-sensitivity C-reactive protein (hsCRP) (P = 0.05), and cardiorespiratory fitness. Changes in CAC among the four groups--no-LSM-placebo (43 ± 30); LSM-placebo (19 ± 7); no-LSM-metformin (1 ± 1) and LSM-metformin (-4 ± 6)--were different (P = 0.03 for ANOVA and linear trend across groups), and the majority of this effect was mediated by metformin. Results are mean ± SEM. Metformin prevents plaque progression in HIV-infected patients with the metabolic syndrome.

Original languageEnglish (US)
Pages (from-to)587-597
Number of pages11
JournalAIDS (London, England)
Volume26
Issue number5
StatePublished - 2012

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Metformin
Life Style
HIV
Coronary Vessels
Placebos
Cardiovascular Diseases
Placebo Effect
Abdominal Obesity
Dyslipidemias
C-Reactive Protein
HIV Infections
Insulin Resistance
Analysis of Variance
Randomized Controlled Trials

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Effects of lifestyle modification and metformin on atherosclerotic indices among HIV-infected patients with the metabolic syndrome. / Fitch, Kathleen; Abbara, Suhny; Lee, Hang; Stavrou, Eleni; Sacks, Rachel; Michel, Theresa; Hemphill, Linda; Torriani, Martin; Grinspoon, Steven.

In: AIDS (London, England), Vol. 26, No. 5, 2012, p. 587-597.

Research output: Contribution to journalArticle

Fitch, K, Abbara, S, Lee, H, Stavrou, E, Sacks, R, Michel, T, Hemphill, L, Torriani, M & Grinspoon, S 2012, 'Effects of lifestyle modification and metformin on atherosclerotic indices among HIV-infected patients with the metabolic syndrome.', AIDS (London, England), vol. 26, no. 5, pp. 587-597.
Fitch, Kathleen ; Abbara, Suhny ; Lee, Hang ; Stavrou, Eleni ; Sacks, Rachel ; Michel, Theresa ; Hemphill, Linda ; Torriani, Martin ; Grinspoon, Steven. / Effects of lifestyle modification and metformin on atherosclerotic indices among HIV-infected patients with the metabolic syndrome. In: AIDS (London, England). 2012 ; Vol. 26, No. 5. pp. 587-597.
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