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HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction

Anne-Lise Paisible1, Chung-Chou H Chang, Kaku A So-Armah

  • 1*Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Departments of †Biostatistics; ‡Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; ‖Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA David Geffen School of Medicine at UCLA, Los Angeles, CA; ¶Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Los Angeles, CA; #VA Medical Center; Department of Medicine, Emory University School of Medicine, Atlanta, GA; **Infectious Disease Section, Department of Medicine, VA North Texas Health Care System, UT Southwestern Medical Center, Dallas, TX; ††Infectious Diseases Section, Michael E. DeBakey VA Medical Center; Baylor College of Medicine, Houston, TX; ‡‡Department of Medicine, University of Washington, Seattle, WA; §§VA Medical Center and George Washington University Medical Center, Washington, DC; ‖‖Department of Internal Medicine, The Mount Sinai Medical Center; Bronx Veterans Affairs Medical Center, NY; ¶¶Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA. ##Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; ***VA Connecticut Healthcare System, West Haven, CT; †††VA Connecticut Healthcare System, West Haven, CT, and Section of General Medicine, Yale University School of Medicine, New Haven, CT; and ‡‡‡Vanderbilt University School of Medicine and Nashville Veterans Affairs Medical Center, Nashville TN.

Journal of Acquired Immune Deficiency Syndromes (1999)
|January 15, 2015
PubMed

Insights

HIV-infected individuals face double the risk of heart attack (acute myocardial infarction) even without major cardiovascular risk factors. Managing these risk factors is crucial for reducing heart attack risk in people with HIV.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • Traditional cardiovascular disease risk factors (CVDRFs) are known to increase acute myocardial infarction (AMI) risk in HIV-infected (HIV+) individuals.
  • This study investigates the independent association between HIV status and incident AMI across different strata of CVDRFs.

Purpose of the Study:

  • To determine if HIV infection independently increases the risk of acute myocardial infarction (AMI) across varying levels of cardiovascular disease risk factors (CVDRFs).
  • To quantify the excess AMI risk associated with HIV in a large cohort of veterans.

Main Methods:

  • A prospective cohort study of 81,322 participants (33% HIV+) from the Veterans Aging Cohort Study Virtual Cohort was conducted.
  • Participants were followed from 2003 to 2009 for incident AMI, with CVDRFs categorized into 6 profiles.
  • Cox models were used to analyze the association between HIV, CVDRFs, and AMI, adjusting for demographics, comorbidity, and substance use.

Main Results:

  • The prevalence of optimal cardiac health (all CVDRFs optimal) was less than 2% in the cohort.
  • Compared to HIV-negative veterans, HIV-positive veterans had higher AMI rates across similar CVDRF profiles.
  • HIV-positive veterans without major CVDRFs had a 2-fold increased risk of AMI (HR: 2.0; 95% CI: 1.0 to 3.9).

Conclusions:

  • Optimal cardiac health is uncommon in this veteran cohort.
  • HIV-positive individuals without major CVDRFs experience a doubled risk of AMI compared to their HIV-negative counterparts.
  • Reducing the burden of CVDRFs may mitigate the excess AMI risk observed in people living with HIV.
Abstract

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