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Leukocyte Count and Coronary Artery Disease Events in People With Human Immunodeficiency Virus: A Longitudinal Study
Emma F Avery1, Julia N Kleynhans1, Bruno Ledergerber2
1University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.
Insights
People with HIV have higher cardiovascular risk. Increased leukocyte count is linked to coronary artery disease (CAD) events, even years prior, independent of other risk factors.
Area of Science:
- Cardiology
- Infectious Diseases
- Hematology
Background:
- People with human immunodeficiency virus (HIV) face elevated cardiovascular disease (CVD) risks.
- Elevated leukocyte counts are a known risk factor for coronary artery disease (CAD) in the general population.
- The association between leukocyte count and CAD risk in people with HIV (PWH) remains under investigation.
Purpose of the Study:
- To investigate the association between leukocyte count and incident coronary artery disease (CAD) events in people with human immunodeficiency virus (PWH).
- To determine if leukocyte count is an independent predictor of CAD in PWH, similar to traditional risk factors.
Main Methods:
- A case-control study nested within the Swiss HIV Cohort Study.
- Inclusion of 536 PWH with a first CAD event and 1464 event-free controls between 2000 and 2021.
- Analysis of univariable and multivariable odds ratios (OR) for CAD events, considering leukocyte count, traditional CAD risk factors, and HIV-related factors.
Main Results:
- PWH with higher leukocyte counts showed a significantly increased risk of CAD events (multivariable adjusted OR = 1.59; 1.09-2.30).
- The association between leukocyte count and CAD events was observed even when measured up to 8 years prior to the event.
- Leukocyte count demonstrated an independent association with CAD risk, comparable to factors like dyslipidemia and diabetes.
Conclusions:
- Higher leukocyte counts are independently associated with an increased risk of CAD events in people with HIV (PWH).
- Leukocyte count represents a significant risk factor for CAD in PWH, on par with established traditional and HIV-related risk factors.
- These findings highlight the importance of monitoring leukocyte counts in PWH for cardiovascular risk assessment.
Background:
People with human immunodeficiency virus (HIV; PWH) have increased cardiovascular risk. Higher leukocyte count has been associated with coronary artery disease (CAD) events in the general population. It is unknown whether the leukocyte-CAD association also applies to PWH.
Methods:
In a case-control study nested within the Swiss HIV Cohort Study, we obtained uni- and multivariable odds ratios (OR) for CAD events, based on traditional and HIV-related CAD risk factors, leukocyte count, and confounders previously associated with leukocyte count.
Results:
We included 536 cases with a first CAD event (2000-2021; median age, 56 years; 87% male; 84% with suppressed HIV RNA) and 1464 event-free controls. Cases had higher latest leukocyte count before CAD event than controls (median [interquartile range], 6495 [5300-7995] vs 5900 [4910-7200]; P < .01), but leukocytosis (>11 000/µL) was uncommon (4.3% vs 2.1%; P = .01). In the highest versus lowest leukocyte quintile at latest time point before CAD event, participants had univariable CAD-OR = 2.27 (95% confidence interval, 1.63-3.15) and multivariable adjusted CAD-OR = 1.59 (1.09-2.30). For comparison, univariable CAD-OR for dyslipidemia, diabetes, and recent abacavir exposure were 1.58 (1.29-1.93), 2.19 (1.59-3.03), and 1.73 (1.37-2.17), respectively. Smoking and, to a lesser degree, alcohol and ethnicity attenuated the leukocyte-CAD association. Leukocytes measured up to 8 years before the event were significantly associated with CAD events.
Conclusions:
PWH in Switzerland with higher leukocyte counts have an independently increased risk of CAD events, to a degree similar to traditional and HIV-related risk factors.
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