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

77 Citations (Scopus)

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

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HIV Infections
Cardiovascular Diseases
Myocardial Infarction
HIV
Veterans
Electrocardiography
Cohort Studies
Cholesterol
Blood Pressure
Death Certificates
Health
International Classification of Diseases
Medicare
Proportional Hazards Models
Comorbidity
Inpatients
Smoking
Demography

Keywords

  • HIV
  • myocardial infarction
  • optimal cardiovascular health

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)
  • Medicine(all)

Cite this

Paisible, A. L., Chang, C. C. H., So-Armah, K. A., Butt, A. A., Leaf, D. A., Budoff, M., ... 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

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

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 68, No. 2, 01.02.2015, p. 209-216.

Research output: Contribution to journalArticle

Paisible, AL, Chang, CCH, So-Armah, KA, Butt, AA, Leaf, DA, Budoff, M, Rimland, D, Bedimo, R, Goetz, MB, Rodriguez-Barradas, MC, Crane, HM, Gibert, CL, Brown, ST, Tindle, HA, Warner, AL, Alcorn, C, Skanderson, M, Justice, AC & Freiberg, MS 2015, 'HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction', Journal of Acquired Immune Deficiency Syndromes, vol. 68, no. 2, pp. 209-216. https://doi.org/10.1097/QAI.0000000000000419
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. / HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction. In: Journal of Acquired Immune Deficiency Syndromes. 2015 ; Vol. 68, No. 2. pp. 209-216.
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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.",
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AU - Leaf, David A.

AU - Budoff, Matthew

AU - Rimland, David

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AU - Gibert, Cynthia L.

AU - Brown, Sheldon T.

AU - Tindle, Hilary A.

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N2 - 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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