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

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