Smoking Cessation Decreases Risk for CVD in HIV Patients

Barbara Boughton

February 25, 2010

February 25, 2010 (San Francisco, California) — The first study to assess the effects of smoking cessation on an HIV population has found that this intervention can significantly decrease cardiovascular disease (CVD) risk in HIV-infected patients, according to research presented here at the 17th Conference on Retroviruses and Opportunistic Infections.

As HIV patients live longer, CVD has become an important cause of their morbidity and mortality. A recent American Heart Association article (Circulation. 2008;118:e29-35) showed that this morbidity and mortality results from traditional risk factors for CVD, such as advancing age, smoking, and dyslipidemia, and from factors such as the direct effects of HIV on the vasculature and adverse effects of certain antiretroviral drugs.

In the study presented here, the effects of smoking and smoking cessation on CVD risk in 27,586 HIV patients from the Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) study, an ongoing international investigation being conducted at 188 clinics in 21 countries, consisting of more than 33,000 HIV patients, were evaluated by Kathy Petoumenos, PhD, from the University of New South Wales in Sydney, Australia, and colleagues.

The researchers found that HIV patients who stopped smoking significantly reduced their risk for CVD, including carotid artery endarterectomy or stroke, myocardial infarction, and coronary heart disease.

In the study, HIV patients who stopped smoking had a 2.32-fold increased risk for CVD at the end of their first year of cessation; after 3 years of smoking cessation, that risk decreased to 1.49-fold, compared with those who never smoked. In contrast, current smokers had a 2.19-fold increased risk for CVD compared with those who never smoked.

"The clinical benefits of stopping smoking have not been previously reported in an HIV positive population," said Dr. Petoumenos in an interview with Medscape HIV/AIDS. "Our study clearly shows that the benefits of stopping smoking that are observed in the general population are also observed in HIV-positive individuals. So smoking cessation should be a key part of HIV management."

The researchers also found that among those who stopped smoking, the risk for myocardial infarction decreased from a 3.7-fold increased risk, compared with those who never smoked, to a 2.0-fold increased risk after 3 years of smoking cessation. Again, myocardial infarction risk was higher in current smokers, who had a 3.4-fold increased risk for heart attack compared with those who never smoked.

When the researchers analyzed rates of coronary heart disease (CHD), an end point that included myocardial infarction and invasive coronary artery procedures, they found a decreased risk among those who stopped smoking, compared with current smokers.

Their results indicated that current smokers were at a 2.5-fold increased risk for CHD, compared with those who never smoked. In the first year after stopping smoking, those who were successful at smoking cessation had a 2.9-fold increased risk for CHD, compared with those who never smoked, but that increased risk went down to 1.83-fold after 3 years of smoking cessation.

Dr. Petoumenos acknowledged that her team did not find any significant decrease in risk for overall mortality associated with stopping smoking. However, they did find that those who quit smoking were more likely to die of HIV/AIDS, whereas smokers died of other causes.

Dr. Petoumenos noted that there were a few limitations to the study. It did not include pack-year information, and the researchers did not have definitive start and stop dates for smoking cessation. "More research is needed in terms of smoking cessation in this population, [as are] studies that look at the potential interaction between antiretroviral treatment and smoking cessation therapies," she said.

"This is a very important paper because it is the first to look at the specific questions of the benefits of smoking cessation for HIV patients. For reasons that we don't know, smoking rates are very high among HIV patients — some studies have suggested more than a 50% rate," said Steven Grinspoon, MD, professor of medicine at Harvard Medical School in Boston, Massachusetts, and chair of the 2008 American Heart Association State of the Science Conference on Cardiovascular Disease and HIV.

"Now we need more research into the reasons why smoking rates are higher in HIV patients, how to get these patients to stop smoking, . .  [and] additional insight into how we can decrease the rate of cardiovascular disease in HIV patients," Dr. Grinspoon told Medscape HIV/AIDS.

Dr. Petoumenos and Dr. Grinspoon have disclosed no relevant financial relationships.

17th Conference on Retroviruses and Opportunistic Infections (CROI): Abstract 124. Presented February 18, 2010.


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