Association Between Depressive Disorders and Incident Acute Myocardial Infarction in Human Immunodeficiency Virus–Infected Adults

Abstract

IMPORTANCE With the advent of highly effective antiretroviral therapy and improved survival, human immunodeficiency virus (HIV)–infected people are living longer and are now at an increased risk for cardiovascular disease (CVD). There is an urgent need to identify novel risk factors and primary prevention approaches for CVD in HIV. Although depression is prevalent in HIV-infected adults and is associated with future CVD in the general population, its association with CVD events has not been examined in the HIV-infected population. OBJECTIVE To examine whether depressive disorders are prospectively associated with incident acute myocardial infarction (AMI) in a large cohort of adults with HIV. DESIGN, SETTING, AND PARTICIPANTS Included in this cohort study were 26 144 HIV-infected veterans without CVD at baseline (1998–2003) participating in the US Department of Veterans Affairs Veterans Aging Cohort Study from April 1, 2003, through December 31, 2009. At baseline, 4853 veterans (19%) with major depressive disorder (MDD; International Classification of Diseases, Ninth Revision [ICD-9] codes 296.2 and 296.3) and 2296 (9%) with dysthymic disorder (ICD-9 code 300.4) were identified. The current analysis was conducted from January 2015 to November 2015. MAIN OUTCOMES AND MEASURES Incident AMI (defined by discharge summary documentation, enzyme/electrocardiography evidence of AMI, inpatient ICD-9 code for AMI (410), or AMI as underlying cause of death [International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code 121]) between the enrollment date and December 31, 2009. RESULTS The mean (SD) age of those with MDD was 47.3 (7.9) years and for those without MDD was 48.2 (9.7) years. During 5.8 years of follow-up, 490 AMI events (1.9%) occurred. Baseline MDD was associated with incident AMI after adjusting for demographics (hazard ratio [HR], 1.31; 95% CI, 1.05–1.62), CVD risk factors (HR, 1.29; 95% CI, 1.04–1.60), and HIV-specific factors (HR, 1.30; 95% CI, 1.05–1.62). Further adjustment for hepatitis C, renal disease, substance abuse, and hemoglobin level (HR, 1.25; 95% CI, 1.00–1.56) and antidepressant use (HR, 1.12; 95% CI, 0.87–1.42) attenuated associations. Baseline dysthymic disorder was not associated with incident AMI. CONCLUSIONS AND RELEVANCE We report novel evidence that HIV-infected adults with MDD have a 30% increased risk for AMI than HIV-infected adults without MDD after adjustment for many potential confounders. Our findings raise the possibility that MDD may be independently associated with incident atherosclerotic CVD in the HIV-infected population.

Association of Increased Chronicity of Depression With HIV Appointment Attendance, Treatment Failure, and Mortality Among HIV-Infected Adults in the United States

“…Depression negatively affects the incidence and management of other chronic diseases such as cardiovascular disease and diabetes, which are increasingly common causes of death in populations with HIV. 24, [50][51][52] Furthermore, depression can have a direct suppressing effect on the immune system. 53 Finally, depression commonly co-occurs with other psychiatric conditions such as posttraumatic stress disorder, generalized anxiety disorder, and alcohol and substance misuse.…”

Readmissions for Depression and Suicide Attempt following Stroke and Myocardial Infarction

“…There are no ICD-9-CM codes for PSD or PMD. Previous studies have used ICD-9-CM codes 296.2x, 296.3x, and 300.4 to identify depression [17][18][19]. The ICD-9-CM definition used in this study fell well within these validated definitions (296.2x, 296.3x, 296.82, 300.4, 309.0, 309.1, 311).…”

Effects of Internet Cognitive-Behavioral Therapy on Depressive Symptoms and Surrogates of Cardiovascular Risk in Human Immunodeficiency Virus: A Pilot, Randomized, Controlled Trial

“…Thus, it stands to reason that depression, possibly through greater levels of systemic inflammation and worse endothelial function, may contribute to the increased risk of CVD observed in PWH [ 13 ]. In fact, we recently demonstrated an increased risk of acute myocardial infarction [ 14 ] and congestive heart failure [ 15 ] in PWH with depression versus those without depression. As such, we hypothesized that treating depressive symptoms would reduce HIV-CVD risk, specifically through improved endothelial function measured as brachial artery flow-mediated dilation (FMD) and through a reduction in systemic inflammation.…”