Patients with HIV have an increased risk for cardiovascular disease (CVD), in particular, a high risk for heart failure (HF) and stroke, according to results published in the Journal of the American Heart Association.
The study included participants with HIV (n=19,798) and age- and sex-matched controls without HIV (n=59,302) from the MarketScan Commercial and Medicare databases from 2009 to 2015. The researchers used validated algorithms to identify incidence of CVDs, including myocardial infarction (MI), HF, atrial fibrillation (AF), peripheral artery disease, stroke, and CVD-related hospitalization. They used adjusted Cox models to estimate hazard ratios (HRs) and 95% CIs of CVD endpoints.
After a mean follow-up of 20 months, the researchers identified 154 MIs (46 among participants with HIV and 108 among controls), 223 cases of HF (116 among participants with HIV and 107 among controls), 93 strokes (46 among participants with HIV and 47 among controls), 397 cases of AF (116 among participants with HIV and 281 among controls), 98 cases of peripheral artery disease (30 among participants with HIV and 68 among controls), and 935 CVD hospitalizations (359 among participants with HIV and 576 among controls).
Rates per 1000 person-years were 1.2, 1.7, 0.7, 3.0, 0.8, and 7.1, respectively.
Compared with controls without HIV, participants with HIV had an HR of 1.3 (95% CI, 0.9-1.9) for MI, 3.2 (95% CI, 2.4-4.2) for HF, 2.7 (95% CI, 1.7-4.0) for stroke, 1.2 (95% CI, 1.0-1.5) for AF, 1.1 (95% CI, 0.7-1.7) for peripheral artery disease, and 1.7 (95% CI, 1.5-2.0) for CVD hospitalization.
After adjusting for unmeasured confounding, the HRs remained similar, with 1.3 (95% CI, 0.8-2.0) for MI, 3.8 (95% CI, 2.8-5.3) for HF, 3.7 (95% CI, 2.2-6.1) for stroke, 1.5 (95% CI, 1.2-2.0) for AF, 1.5 (95% CI, 0.9-2.6) for peripheral artery disease, and 2.1 (95% CI, 1.8-2.5) for CVD hospitalization.
The associations were of similar magnitude for men and women and were stronger in younger than in older people.
“Results from this study can inform future research by highlighting conditions that require increased attention and providing clues on the mechanisms that put [people living with HIV] at greater risk for certain CVDs compared with their uninfected counterparts,” the researchers wrote.
Alonso A, Barnes AE, Guest JL, Shah A, Shao IY, Marconi V. HIV infection and incidence of cardiovascular diseases: an analysis of a large healthcare database. J Am Heart Assoc. 2019;8(14):e012241.