The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group investigated whether combination antiretroviral therapy (ART) increases the risk of myocardial infarction (MI). The study enrolled 23,468 HIV-1-infected patients from 11 cohorts, followed for 36,199 person-years. Over this period, 126 MI events were recorded. The incidence of MI increased with longer exposure to ART, with an adjusted relative rate of 1.26 per year of exposure (95% CI, 1.12–1.41; P<0.001). Other risk factors included older age, smoking, previous cardiovascular disease, and male sex, but not family history of coronary heart disease. Higher total cholesterol, triglycerides, and diabetes were also associated with increased MI risk. Combination ART was independently associated with a 26% relative increase in MI rate per year of exposure during the first four to six years of use. However, the absolute risk was low and must be balanced against the benefits of ART. The study found that metabolic changes from ART, such as dyslipidemia, insulin resistance, and diabetes, are known risk factors for cardiovascular disease. These changes may increase the risk of premature MI, although evidence is inconsistent. The study used a prospective observational design, with data collected on cardiovascular risk factors, lipid levels, and other relevant variables. Follow-up data were collected until February 2002, and outcomes were validated and classified according to standardized criteria. The study had sufficient power to detect a twofold difference in MI incidence between groups. The primary endpoint was MI, and the study aimed to assess the association between ART exposure and MI risk. The study found that patients with no exposure to ART had a lower MI incidence than those exposed to ART. The relative rate of MI increased with longer exposure to ART, and the association remained significant even after adjusting for demographic and cardiovascular risk factors. However, the association was less pronounced when total cholesterol or triglyceride levels were included in the model. The study also found that markers of HIV disease were not independently associated with MI risk. The study concluded that while ART is associated with a modest increase in MI risk, the absolute risk remains low and the benefits of ART in reducing HIV-related mortality and morbidity outweigh the increased risk of MI. The study highlights the need for continued monitoring of cardiovascular outcomes in patients receiving ART, as atherosclerosis may take decades to develop. The study was supported by multiple organizations and was conducted with rigorous quality assurance measures.The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group investigated whether combination antiretroviral therapy (ART) increases the risk of myocardial infarction (MI). The study enrolled 23,468 HIV-1-infected patients from 11 cohorts, followed for 36,199 person-years. Over this period, 126 MI events were recorded. The incidence of MI increased with longer exposure to ART, with an adjusted relative rate of 1.26 per year of exposure (95% CI, 1.12–1.41; P<0.001). Other risk factors included older age, smoking, previous cardiovascular disease, and male sex, but not family history of coronary heart disease. Higher total cholesterol, triglycerides, and diabetes were also associated with increased MI risk. Combination ART was independently associated with a 26% relative increase in MI rate per year of exposure during the first four to six years of use. However, the absolute risk was low and must be balanced against the benefits of ART. The study found that metabolic changes from ART, such as dyslipidemia, insulin resistance, and diabetes, are known risk factors for cardiovascular disease. These changes may increase the risk of premature MI, although evidence is inconsistent. The study used a prospective observational design, with data collected on cardiovascular risk factors, lipid levels, and other relevant variables. Follow-up data were collected until February 2002, and outcomes were validated and classified according to standardized criteria. The study had sufficient power to detect a twofold difference in MI incidence between groups. The primary endpoint was MI, and the study aimed to assess the association between ART exposure and MI risk. The study found that patients with no exposure to ART had a lower MI incidence than those exposed to ART. The relative rate of MI increased with longer exposure to ART, and the association remained significant even after adjusting for demographic and cardiovascular risk factors. However, the association was less pronounced when total cholesterol or triglyceride levels were included in the model. The study also found that markers of HIV disease were not independently associated with MI risk. The study concluded that while ART is associated with a modest increase in MI risk, the absolute risk remains low and the benefits of ART in reducing HIV-related mortality and morbidity outweigh the increased risk of MI. The study highlights the need for continued monitoring of cardiovascular outcomes in patients receiving ART, as atherosclerosis may take decades to develop. The study was supported by multiple organizations and was conducted with rigorous quality assurance measures.