Cardiovascular risk profile in patients with myelopathy associated with HTLV-1☆

Prado, Fabio Luís Silva do; Prado, Renata; Ladeia, Ana Marice Teixeira

doi:10.1016/j.bjid.2017.01.007

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Sumário

Original Articles • Braz J Infect Dis 21 (3) • May-Jun 2017 • https://doi.org/10.1016/j.bjid.2017.01.007 copy

Cardiovascular risk profile in patients with myelopathy associated with HTLV-1^☆ ☆ This article is part of Fabio Prado MSc Thesis of Bahiana School of Medicine and Public Health Post Graduate Course.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

HAM/TSP (HTLV-1-associated myelopathy/tropical spastic paraparesis) is a slowly progressive disease, characterized by a chronic spastic paraparesis. It is not known if the disease carries an independent risk for cardiovascular disease. The objective of this study was to evaluate the cardiovascular risk profile related to HAM/TSP and compare it with the general population.

Methods:

This was a cross-sectional study, with a control group. HAM/TSP patients were evaluated using cardiovascular risk scores (ASCVD RISK, SCORE and Framingham) and inflammatory markers (ultrasensitive CRP and IL-6), and compared with a control group of healthy individuals. We also evaluated the correlation between cardiovascular risk and the functional status of patients with HAM/TSP evaluated by the FIM scale.

Results:

Eighty percent of patients in this study were females, mean age of 51 years (11.3). The control group showed an increased cardiovascular event risk in 10 years when ASCVD was analyzed (cardiovascular risk ≥7.5% in 10 years seen in 43% of patients in the control group vs. 23% of patients with HAM/TSP; p = 0.037). There was no difference in ultrasensitive CRP or IL-6 values between the groups, even when groups were stratified into low and high risk. There was no correlation between the functional status of HAM/TSP patients and the cardiovascular risk.

Conclusions:

In this study, the cardiovascular risk profile of patients with HAM/TSP was better than the risk of the control group.

Keywords:
HTLV-1; HAM/TSP; Cardiovascular risk; C reactive protein; Interleukin-6

Variables	HAM/TSP n = 56	Control n = 56	p-Value^a a Used t test and Mann-Whitney for continuous variables and x 2 or Yate's correction for continuity when appropriate for categorical variables.
Women	45 (80%)	45 (80%)	>0.999
Age (years) (mean SD)	52 (12)	51 (11)	0.790
Race
White	18 (32%)	10 (18%)	0.081
Non-white	38 (68%)	46 (82%)

Education
No formal education	2 (4%)	0
1-3 years	11 (20%)	3 (5%)	<0.001
4-7 years	22 (39%)	6 (11%)
8-10 years	7 (12%)	13 (23%)
>10 years	14 (25%)	34 (61%)
Income
<3 minimum wage salaries	34 (61%)	8 (14%)	<0.001
≥ 3 minimum wage salaries	22 (39%)	48 (86%)

Body mass index (BMI) (kg/m ² )
Waist circumference (cm)	26 (5)	29 (4.7)	<0.001
Women (n = 45)	88 (13)	95 (13)	0.019
Men (n = 11)	93 (17)	98 (10)	0.389
Hypertension	10 (18%)	26 (46%)	0.002
Smoking	4 (7%)	5 (9%)	0.728
Diabetes	9 (16%)	2 (4%)	0.026
Family history of cardiovascular disease^b b First degree relative with history of premature coronary disease (male < 55 years and female < 65 years).	4 (7%)	11 (20%)	0.096
Metabolic syndrome	24 (44%)	33 (60%)	0.127
Total cholesterol (mg/dl)	179 (33)	200 (42)	0.005
LDL cholesterol (mg/dl)	118 (30)	127 (38)	0.167
HDL cholesterol (mg/dl)	39 (9)	47 (10)	0.000
Triglycerides (mg/dl) (median, IQR)	101 (71-152)	132 (95-177)	0.011
Fasting glucose (mg/dl)	90 (83-96)	92 (87-100)	0.200

Variables	HAM/TSP n = 56	Control n = 56	Prevalence ratio (IC95%)	p-Value^d d Used Mann-Whitney for continuous variables and x2 for categorical variables or Yate's correction for continuity when appropriate.
% Patients with intermediate/high risk ^a a Patients with cardiovascular risk ≥5% evaluated by Framingham Score, ≥1% evaluated by SCORE and ≥7.5% evaluated by ASCVD.
ASCVD^b b ASCVD RISK evaluates 10 risk of cardiovascular event in patients with age from 40 to 79 years. n = 49.	23%	43%	0.54 (0.29-0.98)	0.04
Framingham	46%	63%	0.74 (0.53-1.05)	0.09
SCORE	52%	59%	0.88 (0.63-1.23)	0.45

Absolute value ^c c % risk of a cardiovascular event in 10 years.
ASCVD^b b ASCVD RISK evaluates 10 risk of cardiovascular event in patients with age from 40 to 79 years. n = 49. (median, IQR)	3.3 (1.6-7.3)	4.8 (1.9-14.3)		0.11
Framingham	4.8 (2.3-9.9)	7.3 (2.9-16.7)		0.02
Score	0.0 (0-1.75)	1.0 (0-2.00)		0.09

Variables	HAM/TSP n = 56	Control n = 56	p-Value^a a Used Mann-Whitney for continuous variables and x 2 or Yate's correction for continuity when appropriate for categorical variables.
Absolute values
CRP^b b CRP, ultrasensitive C reactive protein; IL-6, Interleucin-6. (mg/l) (median, IQR)	2.6 (1, 5.5)	1.7 (0.8, 5)	0.510
IL-6^b b CRP, ultrasensitive C reactive protein; IL-6, Interleucin-6. (pg/ml) (media,IQR)	2.4 (0, 3.3)	2.4 (0, 3.3)	0.858

Patients with elevated values (%)
CPR^b b CRP, ultrasensitive C reactive protein; IL-6, Interleucin-6. > 3 mg/l	27 (48%)	23 (41%)	0.569
IL-6^b b CRP, ultrasensitive C reactive protein; IL-6, Interleucin-6. > 3.4 pg/ml	12 (23%)	9 (17%)	0.661

Variable	First model OR (IC 95%)	Final model OR (IC 95%)
HAM/TSP	0.4 (0.13-1.01)	0.4 (0.18-1.11)
Education	1.6 (0.60-4.58)	-
Waist circumference	3.6 (0.70-19.03)	3.8 (0.80-18.48)
IMC	1.1 (0.40-2.85)	-

Variable FIM^a a FIM, Functional independence measure. scale score	Spearmen's rho	p-Value
Framingham	0.098	0.595
SCORE	0.048	0.792
ASCVD	0.033	0.869

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[1] *Corresponding author. E-mail address: fabioluisprado@gmail.com (F.L. Prado).

Age of onset of symptoms (years) (mean ± SD)	41 (12, 7)
Duration of disease (years) (median, IQR)	10 (5, 14)
Neurogenic bladder	55 (98%)
Neurogenic bowel	52 (93%)
Lumbar pain	47 (84%)
Uveitis	4 (7%)
FIM^* scale score (n = 32)	111 (109-117)
Proviral load (HTLV-1 copies/10⁵ cells copies/ml)	2511 (286-3518)

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Cardiovascular risk profile in patients with myelopathy associated with HTLV-1☆ ☆ This article is part of Fabio Prado MSc Thesis of Bahiana School of Medicine and Public Health Post Graduate Course.

ABSTRACT

Methods:

Results:

Conclusions:

Cardiovascular risk profile in patients with myelopathy associated with HTLV-1^☆ ☆ This article is part of Fabio Prado MSc Thesis of Bahiana School of Medicine and Public Health Post Graduate Course.