Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals

Abstract

OBJECTIVE Few studies have described mortality and clinical outcomes after myocardial infarction (MI) in the HIV-positive population. This study evaluated changes in short-term mortality after MI in HIV-positive individuals in the D:A:D Study, and investigated possible reasons for any changes seen. DESIGN Prospective cohort study. METHODS Demographic, cardiovascular disease (CVD)/HIVrelated characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarized at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI. RESULTS One thousand and eight HIV-positive individuals experiencing an MI over the period 1999-2014 were included. The absolute number of MIs decreased from 214 (1999-2002) to 154 (2011-2014). Whilst the CVD risk profile remained high over time, the HIV status improved. The use of CVD-related interventions after MI appeared to increase over time. The proportion of individuals who died in the first month after MI dropped from 26.6% in 1999-2002 to 8.4% in 2011-2014. Later calendar year was associated with decreased short-term mortality; this effect was attenuated after adjusting for CVD-related interventions received in the first month after MI [odds ratio changed from 0.88 (95% confidence interval 0.83, 0.93) to 0.97 (0.91, 1.02)]. CONCLUSION Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions. Design: Prospective cohort study.Methods: Demographic, cardiovascular disease (CVD)/HIV-related characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarized at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI. Conclusion: Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions.

Epidemiology of ischemic heart disease in HIV

“…12 The proportionate mortality from CVD has also significantly increased in HIV over time; from 1999 to 2013, overall mortality increased but CVD mortality increased. 13 Yet recent data suggest that absolute rates of myocardial infarction (MI) among HIV-infected individuals are decreasing over time, 14 an advance thought to reflect improvement in recognition and management of CVD risk factors.…”

Pathophysiology of ischaemic heart disease

“…In the DAD study, the observed decrease in CVD-related deaths over time could not be explained by the higher proportion of virologically suppressed individuals, suggesting that deployment of primary prevention measures such as smoking cessation, prescription of lipid-lowering drugs, diet and exercise modifications may be responsible [2]. This hypothesis was supported by a recent study that assessed the short-term mortality after MI in the same cohort [6]. It confirmed that prescription of lipid-lowering drugs and anti-platelet agents resulted in significantly improved survival rates, despite the older age and poorer CVD risk profile of in individuals who experienced an MI.…”

HIV and Cardiovascular Disease: Update on Clinical Events, Special Populations, and Novel Biomarkers

“…There has been recent interest in recurrence of and morbidity and mortality after myocardial infarction. Data from the Data Collection on Adverse Drug Events (D:A:D) study indicates that the proportion of PLWHA dying from a CVD cause after their initial myocardial infarction decreased from 73% in 1999–2002 to 41% in 2011–2014 [59]. They conclude that short-term survival improvements following a myocardial infarction are primarily due to better management of CVD risk factors in PLWHA who have an incident myocardial infarction.…”