The association of HIV infection with cardiovascular disease was particularly strong for heart failure and stroke.
People living with HIV (PLWH) have a higher risk of cardiovascular diseases (CVDs), specifically heart failure and stroke, according to researchers.
The researchers used the MarketScan commercial and Medicare databases to identify 19,798 PLWH and 59,302 age- and sex-matched uninfected individuals during 2009 to 2015. Validated algorithms were used to identify incidence of CVDs, including myocardial infarction (MI), heart failure (HF), atrial fibrillation, peripheral artery disease, stroke, and any CVD-related hospitalization.
“Among PLWH, mortality attributable to CVD is growing in importance. The proportion of deaths attributable to CVD in PLWH in the United States more than doubled between 1999 and 2013, from 2.0% to 4.6%,” the study said. “Extensive evidence shows that HIV infection is an independent risk factor for coronary artery disease and, to a lesser extent, heart failure (HF). Information on the link between HIV infection and other cardiovascular conditions such as stroke, peripheral artery disease (PAD), or atrial fibrillation (AF), however, remains scarce.”
Every participant had a follow-up after an average of 20 months. At this point, patients experienced 154 MIs, 223 HF, 93 strokes, 397 atrial fibrillation, 98 peripheral artery disease, and 935 CVD hospitalizations.
The hazard ratios comparing PLWH with uninfected controls were 1.3 for MI, 3.2 for HF, 2.7 for stroke, 1.2 for atrial fibrillation, 1.1 for peripheral artery disease, and 1.7 for any CVD hospitalization. When adjusted for unmeasured confounding, similar associations were also found.
“In this analysis of a large healthcare claims database, we show that PLWH experience higher rates of several CVDs compared with a group of age and sex‐matched uninfected individuals, independent of cardiovascular risk factors and other comorbidities,” the authors noted. “The association of HIV infection with CVD was particularly strong for HF, stroke, and a broadly defined outcome of CVD hospitalization, as well as for people aged <50 years and those without a prior history of CVD.”
The authors suggested that these results may be used to inform future research by demonstrating the need for increased attention on the mechanisms that put PLWH at a greater risk of certain CVDs compared to those who are uninfected. Furthermore, the study calls for more work to be done involving the recognition, prevention, and treatment of CVD among PLWH.
Alonso A, Barnes AE, Guest J, et al. HIV infection and incidence of cardiovascular diseases: An analysis of a large healthcare database [published online July 2019]. Journal of the American Heart Association. doi: 10.1161/JAHA.119.012241.