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. 2015 Feb 1;68(2):209-16.
doi: 10.1097/QAI.0000000000000419.

HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction

Anne-Lise Paisible  1 , Chung-Chou H Chang, Kaku A So-Armah, Adeel A Butt, David A Leaf, Matthew Budoff, David Rimland, Roger Bedimo, Matthew B Goetz, Maria C Rodriguez-Barradas, Heidi M Crane, Cynthia L Gibert, Sheldon T Brown, Hilary A Tindle, Alberta L Warner, Charles Alcorn, Melissa Skanderson, Amy C Justice, Matthew S Freiberg
Affiliations

HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction

Anne-Lise Paisible et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Traditional cardiovascular disease risk factors (CVDRFs) increase the risk of acute myocardial infarction (AMI) among HIV-infected (HIV+) participants. We assessed the association between HIV and incident AMI within CVDRF strata.

Methods: Cohort-81,322 participants (33% HIV+) without prevalent CVD from the Veterans Aging Cohort Study Virtual Cohort (prospective study of HIV+ and matched HIV- veterans) participated in this study. Veterans were followed from first clinical encounter on/after April 1, 2003, until AMI/death/last follow-up date (December 31, 2009). Predictors-HIV, CVDRFs (total cholesterol, cholesterol-lowering agents, blood pressure, blood pressure medication, smoking, diabetes) used to create 6 mutually exclusive profiles: all CVDRFs optimal, 1+ nonoptimal CVDRFs, 1+ elevated CVDRFs, and 1, 2, 3+ major CVDRFs. Outcome-Incident AMI [defined using enzyme, electrocardiogram (EKG) clinical data, 410 inpatient ICD-9 (Medicare), and/or death certificates]. Statistics-Cox models adjusted for demographics, comorbidity, and substance use.

Results: Of note, 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 with HIV- veterans, AMI rates among HIV+ veterans with similar CVDRF profiles were higher. Compared with HIV- veterans without major CVDRFs, HIV+ veterans without major CVDRFs had a 2-fold increased risk of AMI (HR: 2.0; 95% confidence interval: 1.0 to 3.9; P = 0.044).

Conclusions: The prevalence of optimal cardiac health is low in this cohort. Among those without major CVDRFs, HIV+ veterans have twice the AMI risk. Compared with 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.

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Conflict of interest statement

Conflicts of interest

None of the authors report a relevant conflict of interest

Figures

Figure 1
Figure 1
Age/race-ethnicity adjusted rates of acute myocardial infarction (AMI) by cardiovascular disease risk factor profile (CVDRF) stratified by HIV status (see attached)
See this image and copyright information in PMC

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