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HIV is Associated with Clinically Confirmed Myocardial Infarction after Adjustment for Smoking and Other Risk Factors
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Reported by Jules Levin
CROI 2011 March 2 Boston
Matthew S. Freiberg,1 Kathy McGinnis,2 Adeel Butt,1 Matthew B. Goetz,3 Sheldon Brown,4 Kris Ann Oursler,5 Maria Rodriguez-Barradas,6 Cynthia Gibert,7 David, Rimland,8 and Amy C. Justice2,9
1 University of Pittsburgh School of Medicine, Pittsburgh, PA; 2 VA Connecticut Health Care System, West Haven Veterans Administration Medical Center; 3 David Geffen School of Medicine, UCLA and the VA Greater Los Angeles Health Care System, Los Angeles, CA; 4 James J. Peters VA, Bronx, NY, Mount Sinai School of Medicine, New York, NY; 5 Baltimore VA Medical Center, University of Maryland School of Medicine, Baltimore, MD; 6 Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX; 7 George Washington University School of Medicine and the Washington DC VAMC, Washington, D.C; 8 Emory University School of Medicine and Atlanta VAMC, Atlanta, GA; 9 Yale University School of Medicine, New Haven, CT
CONCLUSIONS
HIV infected participants had an increased risk of AMI as compared to demographically and behaviorally similar HIV uninfected participants after adjusting for important confounders.
HIV infection was associated with the same risk of AMI as diabetes and ever smoking
This association persisted when the sample was restricted to never smokers
The age at and time to an AMI event was the same for HIV infected and uninfected participants
LIMITATIONS
The results may not be generalizable to women
The present study does not include cumulative exposure of ARV classes and does not include time updated HIV-1 RNA and CD4 count levels
ABSTRACT
Methods: We analyzed data on 81,229 veterans (33% HIV+) from the Veterans Aging Cohort Study Virtual Cohort (VACS), a sample of HIV-infected and 2:1 age, gender, race/ethnicity, and clinical site matched uninfected veterans. Variables included HIV status, age, race/ethnicity, hypertension, diabetes, alcohol and cocaine use, self-reported smoking, hepatitis C, lipids, CD4 count, HIV-1 RNA, class of ART and the incidence of MI from October 2003 to September 2008. All subjects were free of cardiovascular diseases at baseline. MI events were adjudicated as part of the VeteransŐ Administration Ischemic Heart Disease Quality Enhancement Research Initiative (IHD QUERI) using a standard protocol.
Results: During a median 4.6 years, there were 497 MI events (44% HIV+). Rates of MI were higher for HIV+ (21.7, 95%CI 19.0 to 24.7) per 10,000 person-years) than uninfected veterans (13.1, 95%CI 11.7 to 14.8 per 10,000 person-years), resulting in an increased relative risk of MI (HR 1.86, 95%CI 1.54 to 2.26) after adjusting for established risk factors including age (HR 1.04, 95%CI 1.03 to 1.05), Hispanic ethnicity (HR 1.35, 95%CI 1.01 to 1.80); hypertension (HR 1.40, 95%CI 1.15 to 1.70); hyperlipidemia (HR 1.29, 95%CI 1.07 to 1.56); diabetes (HR 2.06, 95%CI 1.69 to 2.50); and smoking (HR 1.48, 95%CI 1.14 to 1.93). Among HIV-infected participants, baseline CD4 counts, HIV-1 RNA levels, and class of ART were not associated with MI after adjustment for established risk factors (p >0.2).
Conclusions: HIV infection was associated with an increased risk of adjudicated MI events after adjusting for established risk factors among a cohort of HIV+ and demographically and behaviorally similar uninfected veterans. Future studies assessing the risk of MI among HIV-infected people will need to incorporate time updated CD4 counts, HIV-1 RNA levels, and duration of ART.
BACKGROUND
Whether HIV infection is in fact an independent risk factor for acute myocardial infarction (AMI) remains an important question. Prior studies reporting an association between HIV and AMI were typically limited by the lack of a demographically and behaviorally similar HIV uninfected referent group; clinically confirmed AMI outcomes; and or missing data involving important risk factors such as smoking and substance use and abuse.
The objective of this study was to determine whether HIV infection was an independent risk factor for AMI. an independent risk factor for AMI.
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