HIV Infection, Cardiovascular Disease Risk Factor Profile, and Risk for Acute Myocardial Infarction

Anne-Lise Paisible, MD; Chung-Chou H. Chang, PhD; Kaku A. So-Armah, PhD; Adeel A. Butt, MD; David A. Leaf, MD; Matthew Budoff, MD; David Rimland, MD; Roger Bedimo, MD; Matthew B. Goetz, MD; Maria C. Rodriguez-Barradas, MD; Heidi M. Crane, MD; Cynthia L. Gibert, MD; Sheldon T. Brown, MD; Hilary A. Tindle, MD, MPH; Alberta L. Warner, MD; Charles Alcorn, MA; Melissa Skanderson, MSW; Amy C. Justice, MD, PhD; Matthew S. Freiberg, MD, MSc

Disclosures

J Acquir Immune Defic Syndr. 2015;68(2):209-216. 

In This Article

Abstract and Introduction

Abstract

Background Traditional cardiovascular disease risk factors (CVDRFs) increase the risk of acute myocardial infarction (AMI) among HIV-infected (HIV+) participants. We assessed the association between HIV and incident AMI within CVDRF strata.

Methods Cohort—81,322 participants (33% HIV+) without prevalent CVD from the Veterans Aging Cohort Study Virtual Cohort (prospective study of HIV+ and matched HIV- veterans) participated in this study. Veterans were followed from first clinical encounter on/after April 1, 2003, until AMI/death/last follow-up date (December 31, 2009). Predictors—HIV, CVDRFs (total cholesterol, cholesterol-lowering agents, blood pressure, blood pressure medication, smoking, diabetes) used to create 6 mutually exclusive profiles: all CVDRFs optimal, 1+ nonoptimal CVDRFs, 1+ elevated CVDRFs, and 1, 2, 3+ major CVDRFs. Outcome—Incident AMI [defined using enzyme, electrocardiogram (EKG) clinical data, 410 inpatient ICD-9 (Medicare), and/or death certificates]. Statistics—Cox models adjusted for demographics, comorbidity, and substance use.

Results Of note, 858 AMIs (42% HIV+) occurred over 5.9 years (median). Prevalence of optimal cardiac health was <2%. Optimal CVDRF profile was associated with the lowest adjusted AMI rates. Compared with HIV- veterans, AMI rates among HIV+ veterans with similar CVDRF profiles were higher. Compared with HIV- veterans without major CVDRFs, HIV+ veterans without major CVDRFs had a 2-fold increased risk of AMI (HR: 2.0; 95% confidence interval: 1.0 to 3.9; P = 0.044).

Conclusions The prevalence of optimal cardiac health is low in this cohort. Among those without major CVDRFs, HIV+ veterans have twice the AMI risk. Compared with HIV- veterans with high CVDRF burden, AMI rates were still higher in HIV+ veterans. Preventing/reducing CVDRF burden may reduce excess AMI risk among HIV+ people.

Introduction

With the advent of antiretroviral medications, persons with HIV are living long enough to face significant morbidity and mortality from chronic illness such as cardiovascular disease (CVD).[1–5] Traditional CVD risk factors (eg, diabetes, hypertension, dyslipidemia, smoking), HIV-related risk factors (eg, renal disease), and other risk factors [eg, antiretroviral therapy (ART), substance abuse] contribute to increased risk of CVD in HIV-infected patients.[6,7] Although traditional CVD risk factors are often assessed individually, there is strong evidence that they occur in clusters,[8,9] which can be categorized as CVD risk factor profiles.[10] Comparisons among infected and uninfected people with similar traditional CVD risk factor profiles are needed to more accurately estimate the independent effect of HIV on acute myocardial infarction (AMI) risk. One way to assess the independent effects of HIV versus comorbidity on CVD risk is to compare people with low traditional CVD risk factor burden or even optimal cardiac health, a phenomenon whose prevalence is low among uninfected people but unknown among HIV-infected people.[11,12] Our objectives were to compare the association of HIV status and incident AMI within specific cardiac health profiles and to assess the prevalence of the optimal cardiac health profile by HIV status.

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