The association between alcohol use and cardiovascular disease among people living with HIV: a systematic review

Abstract

Background: People living with HIV-infection (PLWH) have higher prevalence and earlier onset of cardiovascular disease (CVD), compared to uninfected populations. It is unclear how alcohol consumption is related to CVD among PLWH.

Objectives: To summarize the current literature and strength of evidence regarding alcohol consumption as a risk factor for CVD among PLWH, to generate summary estimates for the effect of alcohol consumption on CVD outcomes, and to make recommendations for clinical practice and future research based on the findings and limitations of existing studies.

Methods: A systematic review was conducted using Pubmed/Medline to identify relevant peer-reviewed articles published between 1 January 1999 and 1 January 2014. After critical review of the literature, 13 studies were identified. Risk ratios were extracted or calculated and sample size weighted summary estimates were calculated.

Results: The prevalence of a CVD diagnosis or event ranged from 5.7-24.0%. The weighted pooled crude effect sizes were 1.75 (95% CI 1.06, 3.17) for general and 1.78 (95% CI 1.09, 2.93) for heavy alcohol use on CVD. The pooled adjusted effect size was 1.37 (95% CI 1.02, 1.84) for heavy alcohol use on CVD. Pooled estimates differed by CVD outcome and alcohol measure; alcohol consumption was most significant for cerebral/ischemic events.

Conclusion: HIV clinicians should consider risk factors that are not included in the traditional risk factor framework, particularly heavy alcohol consumption. Neglect of this risk factor may lead to underestimation of risk, and thus under-treatment among PLWH.

Keywords: Alcohol; HIV-infection; cardiovascular disease; review; risk factors.

Figure 1

Study Selection Process.

Figure 2

Crude effect sizes of alcohol use on cardiovascular disease by study. Reference for ‘Any Use’ is no alcohol use; ^aReference is abstinent to low alcohol use; ^bReference is no alcohol abuse or dependence; ^cReference is less than ‘excessive’ alcohol use; OR = odds ratio; 95% CI= confidence interval; Square marker refers to the study effect size; Diamond marker refers to pooled effect size. Horizontal line refers to the 95% CI; Vertical line refers to an OR of 1.0, indicating no effect. Horizontal lines reaching the end of the graph indicate OR or upper 95% CI limit is above 15.0.

Figure 3

Adjusted effect sizes of heavy alcohol use on cardiovascular disease by study providing adjusted risk estimates. ^aReference is abstinent to low alcohol use; ^bReference is less than ‘excessive’ alcohol use; ^cReference is infrequent to moderate alcohol use; ^dReference is no alcohol abuse or dependence; OR = odds ratio; 95% CI= confidence interval; Square marker refers to the study effect size; Diamond marker refers to pooled effect size; Horizontal line refers to the 95% CI; Vertical line refers to an OR of 1.0, indicating no effect. Horizontal lines reaching the end of the graph indicate upper 95% CI limit is above 15.0.