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Predictors of cardiovascular outcomes in older HIV-infected patients: CORE50 Cohort 10-year follow-up / Framingham Score, Depression, Aspirin Predict Cardiovascular Events in Older People With HIV
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IDWeek 2018, October 3-7, 2018, San Francisco
Mark Mascolini
Framingham cardiovascular risk score, depression, and smoking predicted cardiovascular events through 10 years of follow-up in 121 HIV-positive people 50 or older [1]. Taking aspirin cut the risk of death through 10 years.
[from Jules: this is study of 121 HIV+, 90% African-American 23% to 36% had a CVD event: The goal of this study was to identify predictors of CV outcomes and the impact of the Framingham cardiac risk at baseline on CV outcomes and mortality >10 years later. 22 of 82 died, thats a high death rate - 18.2% from CVD, 36.4% from cancers: lung 37%; liver 25%; esophageal 25%; Laryngeal 12.5% - history of depression associated with CVD event; ABC use not associated with CV event or death; history of PI use or current integrate use was associated with increased CV events; statin use did not appear to improve CV outcome but aspirin use did].
Ample research documents excess cardiovascular disease in people with HIV. High prevalence of cardiovascular risk factors, ongoing inflammation, and antiretroviral toxicity all contribute to higher cardiovascular disease rates with HIV. But individual cardiovascular risk predictors in HIV populations, especially older minority populations, remain poorly understood. Researchers at Chicago's Cook County Hospital CORE Center conducted this study to address those issues.
The analysis focused on the CORE50 cohort, a cross-sectional study of HIV-positive people recruited in 2005-2006 when 50 years old or older. Their CD4 count averaged 387 and 67% had an undetectable viral load. Researchers collected follow-up data through 10 years by retrospective chart review, determining how many people died from what causes including cardiovascular disease. The investigators defined cardiovascular disease as myocardial infarction, ischemic stroke, transient ischemic attack, or peripheral arterial disease. They used univariate analysis to assess the impact of demographic and clinical variables on cardiovascular event rates and mortality.
Sixty people (50%) remained in care in 2016, while 22 people (18%) died, 10 (8%) transferred care, and 29 (24%) dropped out of care. In 2016 age averaged 65.5 in the 60 people who stayed in care, their CD4 count averaged 529, and 82% had an undetectable viral load. Among the 22 people who died, age at death averaged 61.5 years. Of the 22 deaths, cancer accounted for 8 (36.4%) while cardiovascular disease or infection each accounted for 4 (18.2%). The remaining 6 deaths were caused by drug overdose (2), organ failure (2), and other or unknown causes (2).
Men accounted for 78% of the 60 people who survived and 64% of the 22 who died, a nonsignificant difference. Blacks made up 92% of survivors and 86% of those who died, also a nonsignificant difference. Eighteen people who died (82%) tested positive for HCV antibody. A baseline Framingham score above 10% was associated with a greater likelihood of a cardiovascular event during 10 years of follow-up (P = 0.05), while an initial Framingham score above 20% meant a higher risk of death through 10 years (P = 0.01). Baseline smoking foretold a higher cardiovascular event rate (P = 0.05), as did smoking during 2016 (P = 0.035).
Ever taking a protease inhibitor or an integrase inhibitor foretold a cardiovascular event (P = 0.01 and P = 0.011), while taking abacavir was not linked to cardiovascular events or death. People who had depression were more likely to have a cardiovascular event during follow-up (P = 0.035). Participants who took aspirin in 2005 had a significantly lower death rate than those who did not (P
The CORE Center team believes their findings suggest the Framingham cardiovascular risk score is useful for risk stratification in HIV-positive people 50 or older. They underlined the impact of depression and smoking on cardiovascular event rates. Although the study population is relatively small and marked by a high dropout rate, the 10 years of follow-up offer a rare view of long-term risk of cardiovascular disease and death in older people with HIV.
Reference
1. Sansom S, Burke K, Adeyemi O. Predictors of cardiovascular outcomes in older HIV-infected patients: CORE50 Cohort 10-year follow-up. IDWeek 2018, October 3-7, 2018, San Francisco. Abstract 2252. Poster at https://idsa.confex.com/idsa/2018/webprogram/Paper70413.html
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