HIV Infection and the Risk of Acute Myocardial Infarction

Abstract

Importance: Whether people infected with human immunodeficiency virus (HIV) are at an increased risk of acute myocardial infarction (AMI) compared with uninfected people is not clear. Without demographically and behaviorally similar uninfected comparators and without uniformly measured clinical data on risk factors and fatal and nonfatal AMI events, any potential association between HIV status and AMI may be confounded.Objective: To investigate whether HIV is associated with an increased risk of AMI after adjustment for all standard Framingham risk factors among a large cohort of HIV-positive and demographically and behaviorally similar (ie, similar prevalence of smoking, alcohol, and cocaine use) uninfected veterans in care.

Bilirubin Is Inversely Associated With Cardiovascular Disease Among HIV‐Positive and HIV‐Negative Individuals in VACS (Veterans Aging Cohort Study)

“…HIV infection has been shown to increase the risk of CVD, independent of established risk factors, by 50% to 100% 2, 3, 4. The mechanisms underlying this increased risk may be mediated by inflammation, immune activation, and oxidative stress 5.…”

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Older Adults

“…15 Nonetheless, even with effective ART, the risk of cardiovascular disease is approximately 50% higher in HIV-infected persons than in uninfected control populations. 16 Importantly, the increased risk of myocardial infarction is not fully accounted for by other comorbidities, or substance use, or by the Framingham or other risk calculators. 16 In addition, HIV infected patients have increased rates of hypertension, heart failure, sudden death and cerebrovascular events.…”

“…16 Importantly, the increased risk of myocardial infarction is not fully accounted for by other comorbidities, or substance use, or by the Framingham or other risk calculators. 16 In addition, HIV infected patients have increased rates of hypertension, heart failure, sudden death and cerebrovascular events.…”

HIV and coronary disease – When secondary prevention is insufficient

“…3,8,9 In a study carried out by the Antiretroviral Therapy Cohort Collaboration, 6 which included 39 272 patients from 13 cohorts of patients receiving HAART between 1996 and 2006 in Europe and the USA, mortality attributed to cardiovascular disease in HIV patients was 7.9% (40% of which was due to CAD or myocardial infarction [MI] and 18% to stroke). The D:A:D study, 7 which was completed later and included 49 731 patients followed between 1999 and 2011 in clinics in Europe, the USA and Australia, reported mortality of 11% due to cardiovascular disease.…”