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Risk Factors for Major Adverse Cardiovascular Events in Antiretroviral Therapy-Treated People with HIV: A Long-Term
Ceren Atasoy Tahtasakal1, Dilek Yıldız Sevgi1, Sibel Yıldız Kaya2
1Department of Infectious Diseases, Health Sciences University Sisli Hamidiye Etfal Training and Researching Hospital, Istanbul, Turkey.
Insights
People living with HIV (PLWH) face increased cardiovascular disease (CVD) risk. Key predictors of major adverse cardiovascular events (MACE) include low CD4+ counts, hypertension, and older age at diagnosis, highlighting the need for proactive cardiovascular care.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Effective antiretroviral therapy (ART) has increased life expectancy for people living with HIV (PLWH).
- Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in PLWH, with major adverse cardiovascular events (MACE) remaining prevalent.
- Limited data exists on MACE in long-term HIV cohorts.
Purpose of the Study:
- To determine the incidence, risk factors, and predictors of MACE in a long-term cohort of PLWH in Istanbul (ACTHIV-IST).
- To identify key factors contributing to cardiovascular risk in this population.
Main Methods:
- Retrospective analysis of 1059 PLWH followed for at least 10 years, excluding those with prior MACE or noncardiac mortality.
- Analysis of traditional CVD risk factors, HIV-related immunovirological parameters, ART, and comorbidities.
- Cox proportional hazards regression was used to identify independent predictors of MACE.
Main Results:
- MACE incidence was 7.55% (80/1059), with a cumulative rate of 11.1%. Most frequent events included ischemic heart disease, myocardial infarction, and sudden cardiac death.
- A CD4+ count <200 cells/mm³ at diagnosis significantly increased MACE risk (4.5-fold) in those without traditional CVD risk factors.
- Independent predictors of MACE were hypertension (HR: 4.74), coronary artery disease (CAD) (HR: 8.49), and older age at HIV diagnosis (HR: 1.031/year). Patients not on indicated statin therapy had higher MACE risk (34% vs. 17%). A higher MACE rate was observed in patients who used protease inhibitors (PIs).
Conclusions:
- Low baseline CD4+ T-cell count, prolonged HIV duration, comorbidities (hypertension, CAD, dyslipidemia), protease inhibitor use, and older age at HIV diagnosis significantly increase MACE risk.
- Early HIV diagnosis, continuous cardiovascular monitoring, appropriate statin initiation, and individualized ART strategies are crucial for reducing MACE-related morbidity and mortality in PLWH.
Abstract:
People living with HIV (PLWH) continue to experience longer life expectancy due to effective antiretroviral therapy (ART). However, cardiovascular disease (CVD) has become a leading cause of morbidity and mortality. Despite improved HIV care, major adverse cardiovascular events (MACE) remain prevalent, with limited data from long-term cohorts. This study aimed to determine the incidence, risk factors, and predictors of MACE in long-term ACTHIV-IST cohort of PLWH in Istanbul. We conducted a retrospective analysis of 1059 patients followed for at least 10 years. Patients with prior MACE or noncardiac mortality were excluded. Traditional CVD risk factors, HIV-related immunovirological parameters, ART, and comorbidities were analyzed using Cox proportional hazards regression. MACE incidence was 7.55% (80/1059) with a cumulative rate of 11.1%. The most frequent events were ischemic heart disease (30.4%), myocardial infarction (27.6%), and sudden cardiac death (18.6%). Among those without traditional CVD risk factors, a CD4+ count <200 cells/mm³ at diagnosis was associated with a 4.5-fold increased MACE risk. Hypertension (hazard ratio [HR]: 4.74), coronary artery disease (CAD) (HR: 8.49), and older age at HIV diagnosis (HR: 1.031/year) were the strongest independent predictors (p < 0.05). Patients who should have used statins but did not were at higher risk of developing MACE (34% vs. 17%) compared to those who did (p < 0.05). Twenty-one statin users of those who had MACE were before the event. A significantly higher MACE rate was observed in patients who used protease inhibitor (PI) compared to those who did not (p = 0.002). Low baseline CD4+ T-cell count, prolonged HIV duration, comorbidities (e.g., hypertension, CAD, and dyslipidemia), PI experienced, and older age at HIV diagnosis significantly increase MACE risk. Early diagnosis, continuous cardiovascular monitoring, start statins if indicated, and individualized ART strategies are essential to reduce MACE-related morbidity and mortality in PLWH.
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