Document Detail


HIV infection and the risk of acute myocardial infarction.
MedLine Citation:
PMID:  23459863     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
IMPORTANCE: Whether people infected with human immunodeficiency virus (HIV) are at an increased risk of acute myocardial infarction (AMI) compared with uninfected people is not clear. Without demographically and behaviorally similar uninfected comparators and without uniformly measured clinical data on risk factors and fatal and nonfatal AMI events, any potential association between HIV status and AMI may be confounded.
OBJECTIVE: To investigate whether HIV is associated with an increased risk of AMI after adjustment for all standard Framingham risk factors among a large cohort of HIV-positive and demographically and behaviorally similar (ie, similar prevalence of smoking, alcohol, and cocaine use) uninfected veterans in care.
DESIGN AND SETTING: Participants in the Veterans Aging Cohort Study Virtual Cohort from April 1, 2003, through December 31, 2009.
PARTICIPANTS: After eliminating those with baseline cardiovascular disease, we analyzed data on HIV status, age, sex, race/ethnicity, hypertension, diabetes mellitus, dyslipidemia, smoking, hepatitis C infection, body mass index, renal disease, anemia, substance use, CD4 cell count, HIV-1 RNA, antiretroviral therapy, and incidence of AMI.
MAIN OUTCOME MEASURE: Acute myocardial infarction.
RESULTS: We analyzed data on 82 459 participants. During a median follow-up of 5.9 years, there were 871 AMI events. Across 3 decades of age, the mean (95% CI) AMI events per 1000 person-years was consistently and significantly higher for HIV-positive compared with uninfected veterans: for those aged 40 to 49 years, 2.0 (1.6-2.4) vs 1.5 (1.3-1.7); for those aged 50 to 59 years, 3.9 (3.3-4.5) vs 2.2 (1.9-2.5); and for those aged 60 to 69 years, 5.0 (3.8-6.7) vs 3.3 (2.6-4.2) (P < .05 for all). After adjusting for Framingham risk factors, comorbidities, and substance use, HIV-positive veterans had an increased risk of incident AMI compared with uninfected veterans (hazard ratio, 1.48; 95% CI, 1.27-1.72). An excess risk remained among those achieving an HIV-1 RNA level less than 500 copies/mL compared with uninfected veterans in time-updated analyses (hazard ratio, 1.39; 95% CI, 1.17-1.66).
CONCLUSIONS AND RELEVANCE: Infection with HIV is associated with a 50% increased risk of AMI beyond that explained by recognized risk factors.
Authors:
Matthew S Freiberg; Chung-Chou H Chang; Lewis H Kuller; Melissa Skanderson; Elliott Lowy; Kevin L Kraemer; Adeel A Butt; Matthew Bidwell Goetz; David Leaf; Kris Ann Oursler; David Rimland; Maria Rodriguez Barradas; Sheldon Brown; Cynthia Gibert; Kathy McGinnis; Kristina Crothers; Jason Sico; Heidi Crane; Alberta Warner; Stephen Gottlieb; John Gottdiener; Russell P Tracy; Matthew Budoff; Courtney Watson; Kaku A Armah; Donna Doebler; Kendall Bryant; Amy C Justice
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JAMA internal medicine     Volume:  173     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-23     Completed Date:  2013-06-24     Revised Date:  2014-04-25    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  614-22     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cohort Studies
Comorbidity
Female
HIV Infections / complications*,  epidemiology
Hepatitis C / epidemiology
Humans
Incidence
Male
Middle Aged
Myocardial Infarction / epidemiology,  etiology*
Prevalence
Risk
Smoking / adverse effects*,  epidemiology
Veterans
Grant Support
ID/Acronym/Agency:
AA013566-10/AA/NIAAA NIH HHS; AA020790/AA/NIAAA NIH HHS; AA020794/AA/NIAAA NIH HHS; HL095136-04/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Evid Based Nurs. 2014 Apr;17(2):43-4   [PMID:  23996161 ]
JAMA Intern Med. 2013 Apr 22;173(8):622-3   [PMID:  23459847 ]

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