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2-3 Times Greater MI & Heart Failure Risk in HIV+ / "rates of CVD hospitalization
were double in HIV infected" - "HIV Infection and Incidence of Cardiovascular Diseases: An Analysis of a Large Healthcare Database"
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PLWH have an elevated risk of CVD, particularly HF and stroke. With the aging of the HIV population, developing interventions for cardiovascular health promotion and CVD prevention is imperative. - Hazard ratios (95% CI) comparing PLWH with uninfected controls were 1.3 (0.9-1.9) for MI, 3.2 (2.4-4.2) for HF, 2.7 (1.7-4.0) for stroke, 1.2 (1.0-1.5) for atrial fibrillation, 1.1 (0.7-1.7) for peripheral artery disease, and 1.7 (1.5-2.0) for any CVD hospitalization. Adjustment for unmeasured confounding led to similar associations (1.2 [0.8-1.8] for MI, 2.8 [2.0-3.8] for HF, 2.3 [1.5-3.6] for stroke, 1.3 [1.0-1.7] for atrial fibrillation, 0.9 [0.5-1.4] for peripheral artery disease, and 1.6 [1.3-1.9] for CVD hospitalization).
We report that PLWH had a 40% increased risk of AF compared with uninfected individuals, independent of other cardiovascular risk factors and considering unmeasured confounding. Inflammation associated with HIV infection as well as direct effects of HIV on the atrial myocardium, as shown by studies reporting high prevalence of left atrial enlargement and myocardial fibrosis in PLWH,32, 33 could explain this association.
After adjustment for age and sex, rates of CVD hospitalization were double in HIV infected patients compared with uninfected controls, with rates of heart failure and stroke at least tripling in HIV infected patients compared with uninfected controls (Table 3, Model 1). In contrast, rates of myocardial infarction, peripheral artery disease, and atrial fibrillation were only 30% to 40% higher in HIV infected patients than controls. Adjustment for cardiovascular risk factors and other potential confounders had only limited impact in the estimates of association, with HR (95% CI) for heart failure, stroke, and CVD hospitalization of 3.2 (2.4-4.2), 2.7 (1.7-4.0), and 1.7 (1.5-2.0), respectively, in HIV infected patients compared with uninfected individuals (Table 3, Model 2). In contrast, HIV infected patients had no or small increased risk of MI (HR 1.3, 95% CI 0.9-1.9), AF (HR 1.2, 95% CI 1.0-1.5) or PAD (HR 1.1, 95% CI 0.7-1.7) compared with uninfected controls. Associations were of a similar magnitude or slightly stronger when the analysis was restricted to individuals without a prior history of CVD (Table S3).
HIV Infection and Incidence of Cardiovascular Diseases: An Analysis of a Large Healthcare Database
Alvaro Alonso, MD, PhD; A. Elise Barnes, MPH; Jodie L. Guest, PhD, MPH; Amit Shah, MD, MSCR; Iris Yuefan Shao, MPH;
Vincent Marconi, MD
JAHA Originally published2 Jul 2019
Abstract
Background
People living with HIV (PLWH) experience higher risk of myocardial infarction (MI) and heart failure (HF) compared with uninfected individuals. Risk of other cardiovascular diseases (CVDs) in PLWH has received less attention.
Methods and Results
We studied 19 798 PLWH and 59 302 age‐ and sex‐matched uninfected individuals identified from the MarketScan Commercial and Medicare databases in the period 2009 to 2015. Incidence of CVDs, including MI, HF, atrial fibrillation, peripheral artery disease, stroke and any CVD‐related hospitalization, were identified using validated algorithms. We used adjusted Cox models to estimate hazard ratios and 95% CIs of CVD end points and performed probabilistic bias analysis to control for unmeasured confounding by race.
After a mean follow‐up of 20 months, patients experienced 154 MIs, 223 HF, 93 stroke, 397 atrial fibrillation, 98 peripheral artery disease, and 935 CVD hospitalizations (rates per 1000 person‐years: 1.2, 1.7, 0.7, 3.0, 0.8, and 7.1, respectively). Hazard ratios (95% CI) comparing PLWH with uninfected controls were 1.3 (0.9-1.9) for MI, 3.2 (2.4-4.2) for HF, 2.7 (1.7-4.0) for stroke, 1.2 (1.0-1.5) for atrial fibrillation, 1.1 (0.7-1.7) for peripheral artery disease, and 1.7 (1.5-2.0) for any CVD hospitalization. Adjustment for unmeasured confounding led to similar associations (1.2 [0.8-1.8] for MI, 2.8 [2.0-3.8] for HF, 2.3 [1.5-3.6] for stroke, 1.3 [1.0-1.7] for atrial fibrillation, 0.9 [0.5-1.4] for peripheral artery disease, and 1.6 [1.3-1.9] for CVD hospitalization).
Conclusions
In a large health insurance database, PLWH have an elevated risk of CVD, particularly HF and stroke. With the aging of the HIV population, developing interventions for cardiovascular health promotion and CVD prevention is imperative.
Clinical Perspective
What Is New?
• Using a large healthcare claims database, we showed that people living with HIV are at increased risk of developing cardiovascular diseases, particularly heart failure and stroke, compared with uninfected individuals.
• Risk of atrial fibrillation was also slightly elevated in people living with HIV compared with uninfected individuals.
• The association of HIV infection with risk of cardiovascular disease was stronger in younger than older individuals.
What Are the Clinical Implications?
• These findings reinforce the importance of primary prevention of cardiovascular disease in people living with HIV.
• Additional research needs to evaluate whether specific screening strategies for identification of subclinical cardiovascular disease, including atrial fibrillation, are needed in people living with HIV.
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