Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

Abstract

Introduction: There is paucity of data related to potential gender differences in the use of interventions to prevent and treat cardiovascular disease (CVD) among HIV-positive individuals. We investigated whether such differences exist in the observational D:A:D cohort study.

Methods: Participants were followed from study enrolment until the earliest of death, six months after last visit or February 1, 2015. Initiation of CVD interventions [lipid-lowering drugs (LLDs), angiotensin-converting enzyme inhibitors (ACEIs), anti-hypertensives, invasive cardiovascular procedures (ICPs) were investigated and Poisson regression models calculated whether rates were lower among women than men, adjusting for potential confounders.

Results: Women (n = 12,955) were generally at lower CVD risk than men (n = 36,094). Overall, initiation rates of CVD interventions were lower in women than men; LLDs: incidence rate 1.28 [1.21, 1.35] vs. 2.40 [2.34, 2.46]; ACEIs: 0.88 [0.82, 0.93] vs. 1.43 [1.39, 1.48]; anti-hypertensives: 1.40 [1.33, 1.47] vs. 1.72 [1.68, 1.77] and ICPs: 0.08 [0.06, 0.10] vs. 0.30 [0.28, 0.32], and this was also true for most CVD interventions when exclusively considering periods of follow-up for which individuals were at high CVD risk. In fully adjusted models, women were less likely to receive CVD interventions than men (LLDs: relative rate 0.83 [0.78, 0.88]; ACEIs: 0.93 [0.86, 1.01]; ICPs: 0.54 [0.43, 0.68]), except for the receipt of anti-hypertensives (1.17 [1.10, 1.25]).

Conclusion: The use of most CVD interventions was lower among women than men. Interventions are needed to ensure that all HIV-positive persons, particularly women, are appropriately monitored for CVD and, if required, receive appropriate CVD interventions.

Keywords: Cardiovascular disease; HIV; cardiovascular disease interventions; cohort studies; gender; myocardial infarction; stroke; women.

Figure 1

Unadjusted rates of initiation (/100 PYRS) of CVD interventions in women and men, total follow‐up period.

Figure 2

Relative rates of receipt of CVD interventions in women compared to men. Multivariate model adjusted for: Age, calendar year, body mass index, total cholesterol, triglycerides, hypertension, previous myocardial infarction, race, smoking status, AIDS, cardiovascular disease (CVD) family history, stroke, diabetes and CVD risk score >10% (individuals having a moderate or high Framingham CVD risk score). CVD, cardiovascular disease; RR, relative rate; 95% CI, 95% confidence interval; LLDs, lipid lowering drugs; ACEIs, Angiotensin‐converting enzyme inhibitors; ICPs, invasive cardiovascular procedures. *p < 0.05.