Study adds to growing literature on aging with HIV as a chronic condition
People living with HIV have higher rates of heart failure, stroke, and hospitalization due to cardiovascular disease compared to uninfected controls, researchers found.
After adjustment for cardiovascular risk factors, patients living with HIV had 3.2-fold higher risk of heart failure, 2.7-fold more stroke risk, and 1.7-fold higher risk of cardiovascular disease hospitalization versus uninfected patients, reported Alvaro Alonso, MD, of Emory University in Atlanta, and colleagues.
However, the risk was more modest or not significant for atrial fibrillation, myocardial infarction, and peripheral artery disease, the authors wrote in the Journal of the American Heart Association.
With a growing population aging with HIV, the link between heart disease and HIV has gained increased attention. Recently, the American Heart Association (AHA) released a scientific statementabout the importance of both HIV specific and general CV risk factors in cardiovascular treatment and prevention in this population.
Indeed, the scientific statement's lead author, Matthew Feinstein, MD, of Northwestern University in Evanston, Illinois cited "HIV's transition from a fatal disease to a chronic condition" in the statement released in June.
Alonso and colleagues noted that while people living with HIV have a known higher risk of myocardial infarction and heart failure, less is known about other types of cardiovascular events in this population compared to uninfected patients.
They examined data from MarketScan commercial and Medicare databases from 2009 to 2015. Overall, about 20,000 people living with HIV and about 59,000 age- and sex-matched controls were included in the analysis. Mean age of both groups of patients was 43, and 19% in the database were women. Hypertension and dyslipidemia were both present in about a quarter of patients, and around 15% were on lipid-lowering medications.
While the authors found stronger associations for higher risk of heart failure, stroke, and CVD hospitalization, atrial fibrillation (HR 1.3, 95% CI 0.9-1.9), myocardial infarction (HR 1.2, 95% CI 1.0-1.5), and peripheral artery disease (HR 1.1, 95% CI 0.7-1.7) were characterized as having "no or small increased risk" in this population.
There was no difference when examining the data by sex, though the authors found evidence of stronger associations in patients younger than age 50 versus those at least age 50 or older. Notably, there was an almost six-fold higher risk of heart failure in younger patients (HR 5.9, 95% 3.4-10.1) -- albeit with wide confidence intervals. There was also a more than two-fold higher risk of heart failure in older patients with HIV (HR 2.5, 95% CI 1.8-3.5).
"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 authors concluded, noting that more work is also needed in recognition, prevention, and treatment of cardiovascular disease in this population.
Alonso disclosed support from the NIH and the American Heart Association.
One co-author disclosed support from the NIH.
Journal of the American Heart Association
Source Reference: Alonso A, et al "HIV Infection and Incidence of Cardiovascular Diseases: An Analysis of a Large Healthcare Database" J Am Heart Assoc 2019; DOI: 10.1161/JAHA.119.012241.
Read the original article on Medpage Today: HIV Linked to Heart Failure, Stroke Risk