Depression and Human Immunodeficiency Virus Infection Are Risk Factors for Incident Heart Failure Among Veterans

Abstract

Background Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among HIV+ adults. We assessed the association between HIV, depression and incident HF. Methods and Results Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (N = 81,427; 26,908 HIV+, 54,519 HIV-) were categorized into four groups: HIV- without major depressive disorder (MDD) [reference]; HIV- with MDD; HIV+ without MDD; and HIV+ with MDD. ICD-9 codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 follow-up years, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% CI, 8.20–10.6). In Cox proportional hazards models, HIV+ participants with MDD had significantly higher risk of HF [adjusted hazard ratio (aHR) = 1.68; 95% CI, 1.45–1.95] compared to HIV- participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV- and HIV+ participants (aHR = 1.21; 1.06–1.37 and 1.29; 1.11–1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (aHR = 0.76; 0.58–0.99). Conclusions Our study is the first to suggest MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF; and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.

Moving Beyond Cardio-Centricity in Heart Failure Risk Stratification

“…This is important because HIV+ patients were more likely to display dyslipidemia, renal disease, anemia, and cocaine abuse compared with HIV− patients. 9 Similarly, participants with MDD displayed greater HF risk factors independently of HIV status, including more diabetes mellitus, hypertriglyceridemia, smoking, and cocaine abuse.…”

“…The authors appropriately conclude that identification and management of MDD are critical in HIV+ patients and that further studies to elucidate the mechanisms linking HIV infection with depression are needed. 9 The authors are to be commended for this important contribution that vertically advances our understanding of the risk factors for HF in people with HIV infection. 9 The prospective, detailed, longitudinal assessment is a real strength, enabling adjustment for the potential confounding variables that also contribute to the greater risk of HF in HIV+ patients independently of MDD.…”

“…9 The authors are to be commended for this important contribution that vertically advances our understanding of the risk factors for HF in people with HIV infection. 9 The prospective, detailed, longitudinal assessment is a real strength, enabling adjustment for the potential confounding variables that also contribute to the greater risk of HF in HIV+ patients independently of MDD. HIV and the antiretroviral therapies used to treat it are known to increase the risk for coronary artery disease, which is the most common cause of HF in the United States.…”

“…9 The authors point out that both disorders are associated with inflammation and vascular dysfunction, which may contribute to the association. Both MDD and HIV also increase the risk of coronary heart disease.…”

“…5 The observation of decreased HF incidence among participants treated with antidepressants, although hypothesis generating, is very exciting because it points to a potentially novel role for MDD intervention above and beyond the indication for the mood disorder per se. 9 The authors appropriately point out that a beneficial effect of antidepressant therapy cannot be proven from these data because this was not a randomized trial. However, there is already sound rationale to treat MDD in people at risk for heart disease such as those with HIV, Borlaug Depression, HIV, and Heart Failure 1603…”