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CARDIOVASCULAR DISEASE MORTALITY
AMONG HIV-INFECTED PERSONS, NEW YORK CITY, 2001-2012
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Reported by Jules Levin
CROI 2015 Feb 23-26, Seattle, WA
David B. Hanna1, Chitra Ramaswamy2, Robert C. Kaplan1, Jorge R. Kizer1, Regina Zimmerman2, Sarah L. Braunstein2 1Albert Einstein College of Medicine, Bronx, NY, USA and 2New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
.....HIV+ have higher rates of CVD vs general population and deaths in HIV+ due to CVD doubled from 7% to 13% as a percent of all deaths in HIV in NYC (from jules: heart disease was a focus of attention at CROI with numerous studies presentations, particularly 3 from Mass General highlighting that many HIV+ appear to have signs of subclinical heart disease & noncalcified plaque, a risky type that can rupture; 2 reports that Atorvaststain & Rosuvastatin can reduce non calcified plaque & reduce carotid imtima media thickness:
"CVD deaths increased from 7% to 13% of all deaths among HIV-diagnosed individuals (p<0.001) In contrast, CVD deaths in the general population decreased from 47% to 39% (p<0.001)......After adjustment for age, sex, race/ethnicity, borough, and year, HIV was associated with a 54% increased rate of CVD death (RR 1.54, 95% CI 1.47-1.62) .......HIV-diagnosed individuals had significantly higher CVD mortality than the general population through age 65, after which CVD mortality was similar or higher in the general population (Fig. 3) For example, among those 45-54 years old, HIV-diagnosed individuals had a 73% increased rate of CVD death compared with the general population (adjusted RR 1.73, 95% CI 1.58-1.89) .......CVD mortality was lower among HIV-diagnosed individuals with a suppressed HIV RNA level (<400 copies/mL) versus an unsuppressed level (age-standardized rate 3.9 vs. 7.7/1,000, p<0.001) However, both rates were still higher than among the general population (3.2/1,000, 95% CI 3.20-3.22) during this time period"
If you are wondering why after 65 HIV+ have less CVD risk vs general population authors suggest in correspondance: "Related to this is that there may be a survival bias among some of the HIV+ individuals who are over 65 -- they may have healthier behaviors, they may be long term non progressors or elite suppressors, they may have experienced fewer adverse effects from long term ART, etc. that have led to their entry into the age 65+ group. In other words, there may be something specific about them beyond simply being HIV+ that has improved their survival. We are considering these explanations as we continue with our analysis, although surveillance data are limited in being able to fully support these possibilities since they do not contain comprehensive treatment data or ongoing data on health behaviors."
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