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

Anne Lise Paisible, 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

Research output: Contribution to journalArticle

93 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)209-216
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume68
Issue number2
DOIs
StatePublished - Feb 1 2015

Keywords

  • HIV
  • myocardial infarction
  • optimal cardiovascular health

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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    Paisible, A. L., Chang, C. C. H., So-Armah, K. A., Butt, A. A., Leaf, D. A., Budoff, M., Rimland, D., Bedimo, R., Goetz, M. B., Rodriguez-Barradas, M. C., Crane, H. M., Gibert, C. L., Brown, S. T., Tindle, H. A., Warner, A. L., Alcorn, C., Skanderson, M., Justice, A. C., & Freiberg, M. S. (2015). HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction. Journal of Acquired Immune Deficiency Syndromes, 68(2), 209-216. https://doi.org/10.1097/QAI.0000000000000419