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. 2016 Oct 15;63(8):1122-1129.
doi: 10.1093/cid/ciw470. Epub 2016 Jul 20.

Trends in Cardiovascular Disease Mortality Among Persons With HIV in New York City, 2001-2012

David B Hanna  1 , Chitra Ramaswamy  2 , Robert C Kaplan  1 , Jorge R Kizer  1   3 , Kathryn Anastos  1   3 , Demetre Daskalakis  2 , Regina Zimmerman  4 , Sarah L Braunstein  2
Affiliations

Trends in Cardiovascular Disease Mortality Among Persons With HIV in New York City, 2001-2012

David B Hanna et al. Clin Infect Dis. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Clin Infect Dis. 2018 Mar 5;66(6):985. doi: 10.1093/cid/cix1043. Clin Infect Dis. 2018. PMID: 29370353 Free PMC article. No abstract available.

Abstract

Background: Cardiovascular disease (CVD) has become more prominent among human immunodeficiency virus (HIV)-infected individuals. The extent to which CVD mortality rates are changing is unclear.

Methods: We analyzed surveillance data for all persons aged ≥13 years with HIV infection between 2001 and 2012 reported to the New York City HIV Surveillance Registry. We examined age-specific and age-standardized mortality rates due to major CVDs. We compared mortality time trends among persons with HIV with the general population, and examined differences among HIV-infected persons by RNA level.

Results: There were 29 588 deaths reported among 145 845 HIV-infected persons. Ten percent of deaths were attributed to CVD as the underlying cause, including chronic ischemic heart disease (42% of CVD deaths), hypertensive diseases (27%), and cerebrovascular diseases (10%). While proportionate mortality due to CVD among persons with HIV increased (6% in 2001 to 15% in 2012, P < .001), the CVD mortality rate decreased from 5.1 to 2.7 per 1000 person-years. After controlling for sex, race/ethnicity, borough of residence, and year, those with HIV had significantly higher CVD mortality than the general population in all age groups through age 65. The CVD mortality rate was highest among viremic persons (adjusted rate ratio [RR], 3.53 [95% confidence interval {CI}, 3.21-3.87]) but still elevated among virally suppressed (<400 copies/mL) persons (adjusted RR, 1.53 [95% CI, 1.41-1.66]) compared with the general population.

Conclusions: Our findings support continued emphasis by HIV care providers on both viremic control and preventive measures including smoking cessation, blood pressure control, and lipid management.

Keywords: HIV infection; cardiovascular disease; mortality; surveillance; viral load.

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Figures

Figure 1.
Figure 1.
Leading underlying causes of death for individuals with human immunodeficiency virus (HIV) infection, by percentage, New York City, 2001–2012. Data reported to the New York City Department of Health and Mental Hygiene by 31 March 2015. Abbreviation: CV, cardiovascular.
Figure 2.
Figure 2.
Age-standardized cardiovascular disease (CVD) mortality rate per 1000 person-years, by human immunodeficiency virus (HIV) status, New York City, 2001–2012. Bars represent 95% confidence intervals (CIs). Note: 95% CIs for persons without HIV are narrower than the symbol representing the point estimate. Data reported to the New York City Department of Health and Mental Hygiene by 31 March 2015.
Figure 3.
Figure 3.
Adjusted association between positive human immunodeficiency virus (HIV) status and cardiovascular disease (CVD) mortality rate, stratified by age group, New York City, 2001–2012. Rate ratios are adjusted for calendar year, sex, race/ethnicity, and borough of residence. Models exclude persons living outside New York City at diagnosis and persons whose residence at diagnosis was unknown. Data reported to the New York City Department of Health and Mental Hygiene by 31 March 2015.
See this image and copyright information in PMC

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