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Trends in Myocardial Infarction risk by HIV status in two U.S. healthcare systems
Alexandra N Lea1, Asya Lyass2, Leo B Hurley1
1Division of Research, Kaiser Permanente Northern California, Pleasanton, California, United States of America.
Insights
People with human immunodeficiency virus (HIV) face a sustained higher risk of myocardial infarction (MI) compared to those without HIV. This increased cardiovascular disease burden necessitates ongoing monitoring and management strategies for the HIV-positive population.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- People with HIV (PLWH) exhibit elevated risks for myocardial infarction (MI) compared to HIV-negative individuals.
- Understanding the long-term trends in MI burden among PLWH is crucial for cardiovascular disease (CVD) pattern analysis and management optimization.
- Real-world evidence is essential to assess if the increased MI risk in PLWH is a persistent issue.
Purpose of the Study:
- To evaluate the association between HIV status and MI risk over time.
- To compare MI risk in people with HIV versus people without HIV across different calendar eras.
- To determine if the increased MI risk in people with HIV has persisted in recent years.
Main Methods:
- A cohort study was conducted using electronic health records from two US healthcare systems.
- Propensity score matching was used to compare people with HIV (PLWH) and people without HIV.
- Cox proportional hazards models analyzed MI risk in two eras: 2005-2009 and 2010-2017, with follow-up through 2020.
Main Results:
- In 2005-2009, the adjusted hazard ratio (HR) for MI in PLWH was 1.10 (95% CI, 0.76-1.60).
- In 2010-2017, the adjusted HR for MI in PLWH increased to 1.66 (95% CI, 1.15-2.39) compared to HIV-negative individuals.
- The observed differences were primarily driven by a decrease in MI risk among people without HIV, while MI risk remained elevated in PLWH.
Conclusions:
- An increased risk of myocardial infarction persists among people with HIV in recent years, relative to the general population.
- Despite decreasing CVD rates in the general population, continued surveillance for MI in PLWH is warranted due to HIV-specific risk factors.
- These findings highlight the need for ongoing cardiovascular risk assessment and management in the HIV-positive population.
Abstract:
People with HIV have a higher risk of myocardial infarction (MI) compared with people without HIV. Real world evidence on whether the increased burden of MI in people with HIV is sustained over time is essential for understanding cardiovascular disease (CVD) patterns, optimizing management, and identifying unmet needs. To help fill this gap, we completed a cohort study of people with HIV and propensity matched people without HIV in two distinct US-based integrated healthcare systems (Kaiser Permanente Northern California and Mass General Brigham). Electronic health records were assessed for association of HIV status on MI risk in two calendar eras defined by baseline year: 2005-2009 and 2010-2017, with maximum 5-year follow-up, through 2020. Cox proportional hazards models were used to obtain adjusted hazard ratios (HR) for HIV status on MI risk overall and by cohort. Adjusted models controlled for demographics and traditional CVD risk factors. We included 9,401 people with HIV (78 with MI) and 29,418 people without HIV (204 with MI). In adjusted models, the HR for MI in people with HIV was 1.10 (95% CI, 0.76, 1.60) for years 2005-2009 and 1.66 (95% CI, 1.15, 2.39) for years 2010-2017 compared with people without HIV, with a corresponding P-interaction between HIV status and calendar era of 0.12. Differences were largely due to decreases in MI risk for people without HIV. The magnitude of HRs by calendar era was consistent across models stratified by cohort. Results showed an increased MI risk persisted among people with HIV in recent years relative to people without HIV, even as CVD rates are decreasing in the general population. In light of known HIV-specific CVD risk factors, continued surveillance for MIs is merited.
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