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Double the Relative Risk for HIV+ Women for Heart Attacks - Highest rates at 65-74 Years Old
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Why has this not gotten much attention & discussion among doctors & PLWH, by officials? Is research meant to be buried or communicated to PLWH & providers & then translated into solutions?? And why 13 years later since this initial research, why have we no devoted enogh research to understand why & to prevent this?
Double the Relative risk for women for Myocardial Infarction occurring at earlier ages - highest rates at age 65-74
the unadjusted AMI rates per 1000 person-years were higher for HIV patients among women (12.71 vs. 4.88 for HIV compared with non-HIV women), but not among men (10.48 vs. 11.44 for HIV compared with non-HIV men).
The RRs (for HIV vs. non-HIV) were 2.98 (95% CI 2.33-3.75; P < 0.0001) for women and 1.40 (95% CI 1.16-1.67; P = 0.0003) for men
African-American race was a significant predictor of AMI among HIV patients, with a RR of 1.43
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We still Do Not Know Why Women With HIV Have Relatively Higher Rates of heart Disease than HIV Men Compared To HIV-negatives: could be higher inflammation for women, earlier onset of menopause may play a role; REPRIEVE study is looking at this question. In Table 3 you clearly see higher rates of Myocardial Infarction in HIV+ at every age increasing with age at the highest at age 65-74. In Table 4 you clearly see the disproportionate affects on HIV+ men, for example look at age 65-74 for HIV+ women the rate is 122.47 vs 19.67 fr HIV- women, 10-times greater, while for HIV+ men 65-74 the rate is only 55.03 & 30.29 for HIV-neg men. Not only do HIV+ men have the highest rates but relative to HIV-negatives much higher than for HIV+ men vs HIV-neg men. This study was conducted in 2007 & we still don’t know why women have higher relative rates & such high rates of MI.
In summary, our data from a large cohort of HIV-infected patients demonstrate increased AMI rates and cardiovascular risk factors compared with a non-HIV population, particularly among women BUT WOMEN WITH HIV had a 3-fold higher risk for heart disease compared to HIV-negative women while for HIV+ men there was a much less risk compared to HIV-neg Men.
The AMI event rate was approximately 2-fold elevated in the HIV cohort, and this difference was seen over multiple age ranges. Relative myocardial infarction rates were greater among women, in comparison with the non-HIV cohort, and this gender-specific difference may account in part for the overall differences we observed. Determining the mechanisms of increased cardiovascular disease and cardiac risk factor rates in HIV-infected women is an important area of future research. Cardiac risk modification strategies are also particularly needed and will be an important component of the long-term care of this population.
Women with HIV Have Higher Relative Risk than HIV+ Men & Higher Risk vs HIV-neg Women
In gender-stratified models, the unadjusted AMI rates per 1000 person-years were higher for HIV patients among women (12.71 vs. 4.88 for HIV compared with non-HIV women), but not among men (10.48 vs. 11.44 for HIV compared with non-HIV men). The RRs (for HIV vs. non-HIV) were 2.98 (95% CI 2.33-3.75; P < 0.0001) for women and 1.40 (95% CI 1.16-1.67; P = 0.0003) for men, adjusting for age, gender, race, hypertension, diabetes, and dyslipidemia. A limitation of this database is that it contains incomplete data on smoking. Smoking could not be included in the overall regression model, and some of the increased risk may be accounted for by differences in smoking rates.
This study investigates AMI events in both HIV and non-HIV patients followed longitudinally at two large U.S. hospitals showing that HIV status was a relatively greater predictor of AMI among women than men
Metabolic changes are common in HIV-infected patients and likely play a role in the development of atherosclerosis, possibly in concert with other cardiac risk factors. Our study demonstrates increased rates of traditional comorbidities, including hypertension, diabetes, and dyslipidemia, seen at rates of 21.2, 11.5, and 23.3 per 100 persons in the HIV cohort,
Risk factors for AMI in stratified models of HIV and non-HIV
We stratified on the basis of HIV status to determine risk factors for AMI within the HIV and non-HIV groups. Among the HIV-infected patients, dyslipidemia was the cardiac risk factor most significantly associated with AMI, controlling for age, race, gender, and other cardiac risk factors (RR 3.65; 95% CI 2.59-5.19; P < 0.0001). Hypertension (RR 1.23; 95% CI 0.90-1.68; P = 0.20) and diabetes (RR 1.33; 95% CI 0.95-1.85; P = 0.09) were also associated with AMI within the HIV group, but these associations did not reach statistical significance. African-American race was a significant predictor of AMI among HIV patients, with a RR of 1.43 (95% CI 1.01-2.00; P = 0.04). Among the non-HIV patients, dyslipidemia was also the cardiac risk factor most significantly associated with AMI, controlling for age, race, gender, and other cardiac risk factors (RR 3.02; 95% CI 2.92-3.12; P < 0.0001). Hypertension (RR 1.62; 95% CI 1.58-1.67; P < 0.0001) and diabetes (RR 1.99; 95% CI 1.93-2.04; P < 0.0001) were significantly associated with AMI in the non-HIV group.
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Increased Acute Myocardial Infarction Rates and Cardiovascular Risk Factors among Patients with Human Immunodeficiency Virus Disease
Abstract
Context: Metabolic changes and smoking are common among HIV patients and may confer increased cardiovascular risk.
Objective: The aim of the study was to determine acute myocardial infarction (AMI) rates and cardiovascular risk factors in HIV compared with non-HIV patients in two tertiary care hospitals.
Design, Setting, and Participants: We conducted a health care system-based cohort study using a large data registry with 3,851 HIV and 1,044,589 non-HIV patients. AMI rates were determined among patients receiving longitudinal care between October 1, 1996, and June 30, 2004.
Main Outcome Measures: The primary outcome was myocardial infarction, identified by International Classification of Diseases coding criteria.
Results: AMI was identified in 189 HIV and 26,142 non-HIV patients. AMI rates per 1000 person-years were increased in HIV vs. non-HIV patients [11.13 (95% confidence interval [CI] 9.58-12.68) vs. 6.98 (95% CI 6.89-7.06)]. The HIV cohort had significantly higher proportions of hypertension (21.2 vs. 15.9%), diabetes (11.5 vs. 6.6%), and dyslipidemia (23.3 vs. 17.6%) than the non-HIV cohort (P < 0.0001 for each comparison). The difference in AMI rates between HIV and non-HIV patients was significant, with a relative risk (RR) of 1.75 (95% CI 1.51-2.02; P < 0.0001), adjusting for age, gender, race, hypertension, diabetes, and dyslipidemia.
In gender-stratified models, the unadjusted AMI rates per 1000 person-years were higher for HIV patients among women (12.71 vs. 4.88 for HIV compared with non-HIV women), but not among men (10.48 vs. 11.44 for HIV compared with non-HIV men). The RRs (for HIV vs. non-HIV) were 2.98 (95% CI 2.33-3.75; P < 0.0001) for women and 1.40 (95% CI 1.16-1.67; P = 0.0003) for men, adjusting for age, gender, race, hypertension, diabetes, and dyslipidemia. A limitation of this database is that it contains incomplete data on smoking. Smoking could not be included in the overall regression model, and some of the increased risk may be accounted for by differences in smoking rates.
Conclusions: AMI rates and cardiovascular risk factors were increased in HIV compared with non-HIV patients, particularly among women. Cardiac risk modification strategies are important for the long-term care of HIV patients.
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