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Clinical Outcomes After Acute Coronary Syndromes or Revascularization Among People Living With HIV: A Systematic
Mohammed Haji1, Michael Capilupi1, Michael Kwok2
1Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.
Insights
Patients living with HIV face higher risks of mortality and major adverse cardiovascular events after acute coronary syndromes or percutaneous coronary interventions. Enhanced secondary prevention strategies are crucial for this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Clinical outcomes following acute coronary syndromes (ACS) or percutaneous coronary interventions (PCIs) in people with HIV are not well understood.
- Existing data require adequate synthesis to inform clinical practice.
Purpose of the Study:
- To compare clinical outcomes and postdischarge treatment in patients with HIV versus an HIV-negative control group after ACS or PCIs.
- To identify disparities in cardiovascular disease management and outcomes.
Main Methods:
- A systematic review and meta-analysis of longitudinal studies were conducted using Ovid MEDLINE, Embase, and Web of Science.
- Included studies compared patients with HIV undergoing ACS or PCI to an HIV-negative control group, with longitudinal follow-up.
- Data extraction followed PRISMA guidelines, and outcomes were pooled using random-effects models.
Main Results:
- The meta-analysis included 15 studies with 9,499 patients with HIV and 1,531,117 controls. Patients with HIV were younger but had higher rates of smoking and illicit drug use.
- Patients with HIV showed significantly increased risks for all-cause mortality (RR, 1.64), major adverse cardiovascular events (RR, 1.11), recurrent ACS (RR, 1.83), and new heart failure admissions (RR, 3.39).
- Prescription rates for statins and beta-blockers were lower in patients with HIV, though not statistically significant.
Conclusions:
- Patients with HIV experience poorer cardiovascular outcomes after ACS or PCI compared to HIV-negative individuals.
- There is a critical need to enhance secondary prevention strategies for cardiovascular disease in people living with HIV.
Importance:
Clinical outcomes after acute coronary syndromes (ACS) or percutaneous coronary interventions (PCIs) in people living with HIV have not been characterized in sufficient detail, and extant data have not been synthesized adequately.
Objective:
To better characterize clinical outcomes and postdischarge treatment of patients living with HIV after ACS or PCIs compared with patients in an HIV-negative control group.
Data Sources:
Ovid MEDLINE, Embase, and Web of Science were searched for all available longitudinal studies of patients living with HIV after ACS or PCIs from inception until August 2023.
Study Selection:
Included studies met the following criteria: patients living with HIV and HIV-negative comparator group included, patients presenting with ACS or undergoing PCI included, and longitudinal follow-up data collected after the initial event.
Data Extraction And Synthesis:
Data extraction was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Clinical outcome data were pooled using a random-effects model meta-analysis.
Main Outcome And Measures:
The following clinical outcomes were studied: all-cause mortality, major adverse cardiovascular events, cardiovascular death, recurrent ACS, stroke, new heart failure, total lesion revascularization, and total vessel revascularization. The maximally adjusted relative risk (RR) of clinical outcomes on follow-up comparing patients living with HIV with patients in control groups was taken as the main outcome measure.
Results:
A total of 15 studies including 9499 patients living with HIV (pooled proportion [range], 76.4% [64.3%-100%] male; pooled mean [range] age, 56.2 [47.0-63.0] years) and 1 531 117 patients without HIV in a control group (pooled proportion [range], 61.7% [59.7%-100%] male; pooled mean [range] age, 67.7 [42.0-69.4] years) were included; both populations were predominantly male, but patients living with HIV were younger by approximately 11 years. Patients living with HIV were also significantly more likely to be current smokers (pooled proportion [range], 59.1% [24.0%-75.0%] smokers vs 42.8% [26.0%-64.1%] smokers) and engage in illicit drug use (pooled proportion [range], 31.2% [2.0%-33.7%] drug use vs 6.8% [0%-11.5%] drug use) and had higher triglyceride (pooled mean [range], 233 [167-268] vs 171 [148-220] mg/dL) and lower high-density lipoprotein-cholesterol (pooled mean [range], 40 [26-43] vs 46 [29-46] mg/dL) levels. Populations with and without HIV were followed up for a pooled mean (range) of 16.2 (3.0-60.8) months and 11.9 (3.0-60.8) months, respectively. On postdischarge follow-up, patients living with HIV had lower prevalence of statin (pooled proportion [range], 53.3% [45.8%-96.1%] vs 59.9% [58.4%-99.0%]) and β-blocker (pooled proportion [range], 54.0% [51.3%-90.0%] vs 60.6% [59.6%-93.6%]) prescriptions compared with those in the control group, but these differences were not statistically significant. There was a significantly increased risk among patients living with HIV vs those without HIV for all-cause mortality (RR, 1.64; 95% CI, 1.32-2.04), major adverse cardiovascular events (RR, 1.11; 95% CI, 1.01-1.22), recurrent ACS (RR, 1.83; 95% CI, 1.12-2.97), and admissions for new heart failure (RR, 3.39; 95% CI, 1.73-6.62).
Conclusions And Relevance:
These findings suggest the need for attention toward secondary prevention strategies to address poor outcomes of cardiovascular disease among patients living with HIV.
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