ABSTRACT Background People living with HIV (PWH) are at increased risk for metabolic and cardiovascular diseases. However, there is no structured prevention strategy for these subjects. The triglyceride‐glucose (TyG) index has shown predictive value for Type 2 diabetes mellitus (T2DM) and cardiovascular events (CVEs) in the general population, but its utility in PWH remains unclear. Methods We conducted a retrospective study including 477 PWH without baseline T2DM. TyG index was calculated as follows: ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)]/2. ROC analysis was used to identify the optimal TyG threshold for T2DM, and logistic regression analysis was used to evaluate the association with T2DM. The association between TyG index and CVEs was investigated using Kaplan–Meier survival analysis and Cox proportional hazards regression models. Results 477 PWH were included. Median age was 38 years and 26% were women. During a median follow‐up of 14.2 years, 38 participants developed T2DM and 45 experienced CVEs. The TyG index demonstrated fair discrimination for incident T2DM (AUC: 0.675, 95% CI 0.591–0.759), with an optimal threshold of 4.78. Participants with TyG ≥ 4.78 had a higher risk of developing T2DM (aOR 2.86, 95% CI 1.35–6.12). PWH in the highest TyG tertile had also higher risk for CVEs compared with those in the lowest tertile (aHR 3.31, 95% CI 1.10–9.97). Conclusion In PWH, a higher TyG index was independently associated with an increased risk of both T2DM and CVEs over long‐term follow‐up. The TyG index represents a practical, low‐cost tool for early metabolic risk stratification in this population.
Daniele Pastori, G. Gazzaniga, T. Brogi et al.· European Journal of Clinical...· 0 citations
Atrial fibrillation (AF) and cancer frequently coexist, particularly in elderly patients, creating a complex clinical scenario with both increased thromboembolic and hemorrhagic risk. In these patients, in addition to established risk factors, cancer-related factors, such as thrombocytopenia, organ dysfunction, and drug-drug interactions, should be considered when managing anticoagulant treatment. Despite the growing prevalence of this clinical overlap, cancer patients have been under-represented in randomized controlled trials of direct oral anticoagulants for AF. Consequently, evidence guiding anticoagulation decisions in this population derives largely from post-hoc analyses and observational studies. The CHA₂DS₂-VA(Sc) and HAS-BLED scores, widely used for thromboembolic and bleeding risk stratification in the general AF population, have demonstrated suboptimal predictive performance in cancer patients, underscoring the need for a risk factor based approach specific for cancer patients. Emerging data consistently suggest that direct oral anticoagulants (DOACs) are at least as effective and safe as vitamin K antagonists (VKAs) in cancer patients with AF, with potential advantages in reducing stroke, major and intracranial bleeding, and mortality. However, DOACs use is still debated in some settings such as gastrointestinal and genitourinary cancer, brain metastasis and in case of strong drug-drug interactions. This review summarizes current evidence on ischemic and bleeding risk assessment in cancer patients with AF, evaluates the performance of existing risk stratification tools, identifies cancer-specific bleeding risk factors, and proposes a practical management algorithm for anticoagulation in this challenging population.
D. Menichelli, F. Biccirè, A. Cesaro et al.· Polish Archives of Internal...· 0 citations
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