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Published on: August 8, 2013
Association of C-reactive protein and HIV infection with acute myocardial infarction
Virginia A Triant1, James B Meigs, Steven K Grinspoon
1Division of Infectious Diseases, Brigham and Women's Hospital (BWH), Harvard Medical School, Boston, MA, USA.
Insights
Elevated C-reactive protein (CRP) and HIV infection independently increase the risk of acute myocardial infarction (AMI). Patients with both conditions face a significantly higher risk, suggesting CRP measurement aids cardiovascular risk assessment in HIV patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Clinical Research
Background:
- Elevated C-reactive protein (CRP) is a marker of inflammation.
- Human Immunodeficiency Virus (HIV) infection is associated with increased cardiovascular risk.
Purpose of the Study:
- To determine if elevated CRP and HIV infection are independent risk factors for acute myocardial infarction (AMI).
- To assess the combined impact of elevated CRP and HIV on AMI risk.
Main Methods:
- Retrospective analysis of 70,357 patients from January 1997 to December 2006.
- Multivariate logistic regression adjusted for demographic and cardiovascular covariates.
- Included both CRP and high-sensitivity CRP assays.
Main Results:
- Elevated CRP and HIV were independently associated with AMI in univariate and multivariate analyses.
- Adjusted odds ratios for AMI were 2.13 for elevated CRP and 1.93 for HIV.
- Patients with both elevated CRP and HIV had a >4-fold increased risk of AMI.
Conclusions:
- Elevated CRP and HIV are independent predictors of increased AMI risk.
- Combined elevation of CRP and presence of HIV markedly increases relative AMI risk.
- CRP measurement may enhance cardiovascular risk assessment in HIV-positive individuals.
Objective:
To investigate whether elevated C-reactive protein (CRP) levels and HIV infection are independently associated with acute myocardial infarction (AMI) among patients receiving care in a large US health care system.
Methods:
Analyses included patients receiving care in the Partners HealthCare System between January 1997 and December 2006, with a most recent CRP less than 3 years and more than 1 week before AMI. Over this period, 70,357 (487 HIV and 69,870 non-HIV) patients met these criteria, from the background population of 1,648,687 patients followed in the system. We included both CRP and high-sensitivity CRP and defined elevated CRP based on the normal range of the assay used. We used multivariate logistic regression analysis to test the association of elevated CRP and HIV with AMI after adjustment for demographic and other cardiovascular covariates, including hypertension, diabetes, and dyslipidemia.
Results:
In univariate analyses, elevated CRP and HIV were each significantly associated with AMI [odds ratio (OR) 2.51; 95% confidence interval (CI) 2.27 to 2.78; P < 0.0001 for elevated CRP and OR 2.07; 95% CI 1.31 to 3.10; P = 0.001 for HIV]. In a combined model including CRP category and HIV status, elevated CRP (OR 2.50; 95% CI 2.26 to 2.77; P < 0.0001) and HIV (OR 1.74; 95% CI 1.10 to 2.61; P = 0.01) were both independently associated with AMI. In a fully adjusted model controlling for age, sex, race, hypertension, diabetes, and dyslipidemia, both elevated CRP (OR 2.13; 95% CI 1.92 to 2.37; P < 0.0001) and HIV (OR 1.93; 95% CI 1.21 to 2.93; P = 0.004) remained independently associated with AMI. Compared with patients with normal CRP and without HIV, the OR for AMI was increased more than 4-fold among patients with HIV and elevated CRP.
Conclusions:
Elevated CRP and HIV are independently associated with increased AMI risk, and patients with HIV with increased CRP have a markedly increased relative risk of AMI. Measurement of CRP may be useful in the cardiovascular risk assessment of patients with HIV.
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