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Proportion of HIV Deaths Due to Heart Disease Almost Doubles in France From 2000 to 2010
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20th Conference on Retroviruses and Opportunistic Infections, March 3-6, 2013, Atlanta
Mark Mascolini
From 2000 to 2010 the fraction of deaths caused by cardiovascular disease in HIV-positive people in France jumped from 8% to 14%, according to results of national surveys [1]. From 2005 to 2010, heart disease replaced liver disease as the third-leading cause of death in people with HIV.
The ANRS EN20 Mortalite 2010 survey created a national sample of 90 clinical sites providing HIV care. The investigators used a standardized questionnaire to determine causes of death according to the International Classification of Diseases-10th Revision. The study considered unexplained sudden deaths as cardiovascular deaths "because coronary atherosclerosis, cardiomyopathy, anomalous origin of a coronary artery, congenital heart disease, cardiac tumors, valvular heart disease, and inflammatory processes are among the many cardiac causes of sudden unexplained deaths." This analysis aimed to describe cardiovascular-related deaths among HIV-positive people living in France in 2010 and to track the evolution of these deaths from the 2000 and 2005 surveys.
In 2010 the researchers counted 728 deaths in people with HIV, including 182 AIDS deaths (25.0%), 161 non-AIDS nonhepatic cancers (22.1%), and 99 cardiovascular deaths (13.6%), including 73 definite cardiovascular deaths and 26 unexplained sudden deaths. Liver disease deaths fell from third place in the 2005 survey to fourth place in the 2010 survey, accounting for 77 deaths (10.6%). In 2010 infection caused 68 deaths (9.3%).
In the three national HIV surveys, the proportion of deaths caused by heart disease climbed from 8% in 2000, to 10% in 2005, and to 14% in 2010, a highly significant change (P < 0.0001). In 2010 median age of people dying of heart disease stood at 52, versus 50 for those dying from other causes (P = 0.02) and 49 for those dying of AIDS.
Among the 99 deaths from cardiovascular disease, 29 (29%) were attributed to myocardial infarction, 26 (26%) to sudden death, 19 (19%) to stroke, 8 (8%) to cardiac failure, 5 (5%) to pulmonary arterial hypertension, and 5 (5%) to arterial or deep venous thrombosis. The proportion of heart deaths due to myocardial infarction remained nearly the same from 2000 to 2010, while the proportion due to sudden death more than doubled and the proportion due to cardiac failure fell by half.
In 2010 the proportion of people dying from heart disease who were men (78%) did not differ significantly from the proportion of men dying from other causes (75%) (P = 0.53). A significantly lower proportion of cardiovascular deaths than other deaths occurred in the hospital (46% versus 72%, P < 0.0001). Median last CD4 count in people who died of heart disease was 362, compared with 294 in those who died of other causes and 66 in those who died of AIDS.
In 2010 three quarters of people who died of heart disease were smokers, but that high rate did not differ much from the proportion of smokers among people who died of other causes. About one third of people who died of cardiovascular disease (32%) had hypertension, 25% had abnormal lipids, 13% had diabetes, and 40% were injection drug users.
From 2000 to 2010 median age at cardiovascular death rose from 45 to 52 (P < 0.0001), median HIV duration more than doubled from 8 to 18 years (P < 0.0001), median treatment duration more than tripled from 4 to 13 years (P < 0.0001), smoking prevalence climbed from 50% to 75% (P = 0.008), and proportion of injection drug users jumped from 14% to 40% (P < 0.0001).
The investigators cautioned that the 8% to 14% rise in proportion of heart deaths in France can be partly explained by changing the definition to include unexplained sudden death. They added that the frequency of classic cardiovascular risk factors--smoking, diabetes, hyperlipidemia, high blood pressure, and age over 50--"may contribute deeply to this evolution."
The French team suggested their findings emphasize "the need to improve management of HIV-infected patients receiving antiretroviral treatment, especially reinforcing prevention initiatives against cardiovascular risk factors."
Reference
1. Henard S, Roussillon C, Bonnet F, et al. Cardiovascular-related deaths in HIV+ patients between 2000 and 2010: Agence Nationale de Recherche sur le Sida EN20 Mortalite 2010 Survey. 20th Conference on Retroviruses and Opportunistic Infections. March 3-6, 2013. Atlanta. Abstract 1048.
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