Coronary Heart Disease in HIV-Infected Individuals

Abstract

It is currently unknown whether there is an increased risk of coronary heart disease (CHD) in patients with HIV infection. In addition, the contribution of antiretroviral therapy (ART) to CHD risk has not been quantified. We reviewed administrative claims data for HIV-infected and -uninfected individuals from the California Medicaid population and compared the incidence of and relative risk (RR) for CHD using log-linear regression analyses between groups. The association between exposure to ART and CHD incidence was also assessed. Of 3,083,209 individuals analyzed, 28,513 were HIV-infected. The incidence of CHD among young men (up to age 34) and women (up to age 44) with HIV infection was significantly higher than that among non-HIV-infected individuals. The covariate-adjusted RR for the development of CHD in individuals receiving ART compared with those not receiving ART was 2.06 (P < 0.001) in HIV-infected individuals aged 18-33 years. There were no statistically significant associations between ART exposure and CHD in other age groups. CHD incidence appears accelerated among young HIV-infected individuals. Strategies to reduce CHD risk should be incorporated into HIV primary care.

Underutilization of Statins for Prevention of Cardiovascular Disease among Primarily African-American HIV-Infected Patients

“…The most common HIV risk factor was injection drug use (IDU) (60.5%). The median CD4 cell count was 343 cells/mm 3 . The majority were receiving ART (87%) with mostly protease inhibitors and nucleoside reverse transcriptase inhibitors, and 55.5% were virologically suppressed.…”

“…Coronary heart disease (CHD) represents a major cause of death in HIV-infected patients [1][2][3][4][5][6]. Many factors contribute to premature CHD risk in HIV-infected individuals including traditional CHD risk factors (dyslipidemia, hypertension, diabetes), lifestyle factors (cigarette smoking and illicit substance use), and HIV-related (inflammation, hypercoagulability, immune activation, effects of antiretroviral therapy (ART) [6][7][8][9][10][11][12].…”

Longitudinal changes in serum lipids among HIV‐infected men on highly active antiretroviral therapy

“…The incidence of cardiovascular events among HAART recipients has been assessed in several large cohort and database studies [15][16][17][18][19]. In aggregate, these studies suggest a small but significant increase in the risk [20][21][22].…”

The use of the Framingham equation to predict myocardial infarctions in HIV‐infected patients: comparison with observed events in the D:A:D Study

“…In addition, this analysis would also help to determine whether the observed increased risk of MI with duration of CART can be explained by changes in conventional cardiovascular risk factors that occur over time. We hypothesized that, if the increased risk was mediated through such risk factors, then it would be expected that the predicted rates of MI would parallel the increased rates observed with increasing duration of CART during follow up, both overall and according to age and gender [15][16][17].A basic principle of prevention is that the intensity of risk-reduction measures should be adjusted to a person's absolute risk. Various preventive guidelines have been developed for background populations, although the absolute risk cut-off point varies [18][19][20][21][22].…”