HIV Infection, Cardiovascular Disease Risk Factor Profile, and Risk for Acute Myocardial Infarction

Abstract

Background Traditional cardiovascular disease risk factors (CVDRFs) increase the risk of acute myocardial infarction (AMI) among HIV infected (HIV+) patients. We assessed the association between HIV and incident AMI within CVDRF strata. Methods Cohort 81322 participants (33% HIV+) without prevalent CVD from the Veterans Aging Cohort Study-Virtual Cohort (prospective study of HIV+ and matched HIV− veterans). Veterans were followed from first clinical encounter on/after 4/1/2003 until AMI/death/last follow-up date (12/31/2009). Predictors HIV, CVDRFs (total cholesterol, cholesterol-lowering agents, blood-pressure (BP), BP medication, smoking, diabetes) used to create 6 mutually exclusive profiles: all CVDRFs optimal, 1+ non-optimal CVDRFs, 1+ elevated CVDRFs, and 1, 2, 3+ major CVDRFs. Outcome Incident AMI (defined using enzyme, EKG clinical data, 410 inpatient ICD-9 (Medicare), and/or death certificates). Statistics: Cox models adjusted for demographics, comorbidity, and substance use. Results 858 AMIs (42% HIV+) occurred over 5.9 years (median). Prevalence of optimal cardiac health was <2%. Optimal CVDRF profile was associated with the lowest adjusted AMI rates. Compared to HIV− veterans, AMI rates among HIV+ veterans with similar CVDRF profiles were higher. Compared to HIV− veterans without major CVDRFs, HIV+ veterans without major CVDRFs had a 2-fold increased risk of AMI (HR: 2.0 95%CI: 1.0–3.9, p=0.044). Conclusion The prevalence of optimal cardiac health is low in this cohort. Among those without major CVDRFs, HIV+ veterans have twice the AMI risk. Compared to HIV− veterans with high CVDRF burden, AMI rates were still higher in HIV+ veterans. Preventing/reducing CVDRF burden may reduce excess AMI risk among HIV+ people.

Underutilization of Statins for Prevention of Cardiovascular Disease among Primarily African-American HIV-Infected Patients

“…Coronary heart disease (CHD) represents a major cause of death in HIV-infected patients [1][2][3][4][5][6]. Many factors contribute to premature CHD risk in HIV-infected individuals including traditional CHD risk factors (dyslipidemia, hypertension, diabetes), lifestyle factors (cigarette smoking and illicit substance use), and HIV-related (inflammation, hypercoagulability, immune activation, effects of antiretroviral therapy (ART) [6][7][8][9][10][11][12].…”

Enfermedad cardiovascular y metabólica en pacientes infectados por el virus de la inmunodeficiencia humana

“…Grandes estudios observacionales de cohorte demostraron consistentemente mayores tasas de ECV, incluyendo IAM entre los infectados con VIH en comparación con los controles no infectados, con un aproximado de 1,5 a 2 veces mayor riesgo relativo en la última década [36][37][38][39][40][41] . Datos recientes han reforzado estos hallazgos, por ejemplo en un estudio de más de 27 000 pacientes infectados con VIH, las tasas de IAM fueron mayores para pacientes VIH en todos los grupos etarios en comparación con los pacientes control emparejados 39 .…”

Effect of antiretroviral therapy on allele-associated Lp(a) level in women with HIV in the Women's Interagency HIV Study

“…The mean age of the cohort was 38 ± 8 years (range: 20 to 66 years); most were African-Americans (~70%). Among the HIV-seropositive women, 58% had a CD4+ T cell count of <350 cells/mm 3 and 67% had an HIV RNA viral load of ≥10,000 copies/mL. The average duration of diagnosed HIV infection was 6.7 ± 3.7 years.…”

“…As apo(a) is hepatically derived, we tested the impact of presence of HCV co-infection on changes in (2,3,(36)(37)(38). CVD in HIV is multifactorial in nature, resulting from a complex interplay between diverse components, such as genetic and environmental factors, as well as heightened state of systemic inflammation and immune activation intrinsic to HIV infection.…”

“…Human immunodeficiency virus (HIV) infection is associated with a 50-100% greater risk of CVD beyond that explained by traditional CVD risk factors (2), and even among those without traditional CVD risk factors, the risk is 2-fold higher (3). Furthermore, some studies have shown an association between antiretroviral therapy (ART) and CVD risk in HIV-seropositive individuals (4)(5)(6).…”