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Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with HIV
Lydia N Drumright1,2, Robin M Nance1, Stephanie A Ruderman1
1University of Washington, Seattle, Washington, USA.
Insights
Smoking increases myocardial infarction (MI) risk in people with HIV. Reducing smoking, even without full cessation, is crucial for preventing both type 1 (T1MI) and type 2 MI (T2MI).
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- People with HIV (PLWH) have a higher risk of myocardial infarction (MI) compared to the general population.
- PLWH exhibit higher rates of smoking and alcohol consumption, known risk factors for MI.
- The differential impact of smoking and alcohol on specific MI types (atherothrombotic plaque disruption vs. oxygen demand-supply mismatch) remains understudied in PLWH.
Purpose of the Study:
- To investigate the longitudinal associations between smoking and alcohol consumption patterns and the risk of type 1 MI (T1MI) and type 2 MI (T2MI) in people living with HIV.
- To determine the impact of smoking quantity and frequency, as well as alcohol consumption patterns, on MI subtypes.
- To explore potential sex-based differences in the relationship between substance use and MI types.
Main Methods:
- Utilized longitudinal data from the Centers for AIDS Research Network of Integrated Clinical Systems (CFAR) cohort.
- Employed time-updated Cox proportional hazards models to analyze the impact of smoking and alcohol consumption.
- Assessed adjudicated T1MI and T2MI events in a cohort of 13,506 people living with HIV over a median follow-up of 4 years.
Main Results:
- Current smoking was associated with a 60% increased risk for both T1MI and T2MI.
- Each daily cigarette increased T1MI risk by 4% and T2MI risk by a non-significant 2%.
- Gender differences were observed: smoking impacted T1MI more in men and T2MI more in women; increasing alcohol use lowered T1MI risk but not T2MI risk.
Conclusions:
- Findings underscore the importance of prioritizing smoking reduction and cessation among people living with HIV to prevent MI.
- Interventions should consider the differential impact of smoking on MI types and potential gender-specific effects.
- Further research may explore the mechanisms behind alcohol's potential protective effect on T1MI in this population.
Objectives:
People with HIV have a higher risk of myocardial infarction (MI) than the general population, with a greater proportion of type 2 MI (T2MI) due to oxygen demand-supply mismatch compared with type 1 (T1MI) resulting from atherothrombotic plaque disruption. People living with HIV report a greater prevalence of cigarette and alcohol use than do the general population. Alcohol use and smoking as risk factors for MI by type are not well studied among people living with HIV. We examined longitudinal associations between smoking and alcohol use patterns and MI by type among people living with HIV.
Design And Methods:
Using longitudinal data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort, we conducted time-updated Cox proportional hazards models to determine the impact of smoking and alcohol consumption on adjudicated T1MI and T2MI.
Results:
Among 13 506 people living with HIV, with a median 4 years of follow-up, we observed 177 T1MI and 141 T2MI. Current smoking was associated with a 60% increase in risk of both T1MI and T2MI. In addition, every cigarette smoked per day was associated with a 4% increase in risk of T1MI, with a suggestive, but not significant, 2% increase for T2MI. Cigarette use had a greater impact on T1MI for men than for women and on T2MI for women than for men. Increasing alcohol use was associated with a lower risk of T1MI but not T2MI. Frequency of heavy episodic alcohol use was not associated with MI.
Conclusions:
Our findings reinforce the prioritization of smoking reduction, even without cessation, and cessation among people living with HIV for MI prevention and highlight the different impacts on MI type by gender.
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