Differences between HIV‐infected and uninfected adults in the contributions of smoking, diabetes and hypertension to acute coronary syndrome: two parallel case–control studies

Abstract

Objectives The aim of the study was to assess the separate contributions of smoking, diabetes and hypertension to acute coronary syndrome (ACS) in HIV‐infected adults relative to uninfected adults. Methods Two parallel case–control studies were carried out. In the first study, HIV‐positive adults diagnosed with ACS between 1997 and 2009 (HIV+/ACS) were matched for age, gender and known duration of HIV infection with HIV‐positive adults without ACS (HIV+/noACS), each individual in the HIV+/ACS group being matched with three individuals in the HIV+/noACS group. In the second study, each individual in the HIV+/ACS group in the first study was matched for age, gender and calendar date of ACS diagnosis with three HIV‐negative individuals diagnosed with ACS between 1997 and 2009 (HIV–/ACS). Each individual in the HIV–/ACS group was then matched for age and gender with an HIV‐negative adult without ACS (HIV–/noACS). After matching, the ratio of numbers of individuals in the HIV+/ACS, HIV+/noACS, HIV–/ACS and HIV–/noACS groups was therefore 1 : 3 : 3 : 3, respectively. We performed logistic regression analyses to identify risk factors for ACS in each case–control study and calculated population attributable risks (PARs) for smoking, diabetes and hypertension in HIV‐positive and HIV‐negative individuals. Results There were 57 subjects in the HIV+/ACS group, 173 in the HIV+/noACS group, 168 in the HIV–/ACS group, and 171 in the HIV–/noACS group. Independent risk factors for ACS were smoking [odds ratio (OR) 4.091; 95% confidence interval (CI) 2.086–8.438; P < 0.0001] and a family history of cardiovascular disease (OR 7.676; 95% CI 1.976–32.168; P = 0.0003) in HIV‐positive subjects, and smoking (OR 4.310; 95% CI 2.425–7.853; P < 0.0001), diabetes (OR 5.778; 95% CI 2.393–15.422; P = 0.0002) and hypertension (OR 6.589; 95% CI 3.554–12.700; P < 0.0001) in HIV‐negative subjects. PARs for smoking, diabetes and hypertension were 54.35 and 30.58, 6.57 and 17.24, and 9.07 and 38.81% in HIV‐positive and HIV‐negative individuals, respectively. Conclusions The contribution of smoking to ACS in HIV‐positive adults was generally greater than the contributions of diabetes and hypertension, and was almost twice as high as that in HIV‐negative adults. Development of effective smoking cessation strategies should be prioritized to prevent cardiovascular disease in HIV‐positive adults.

Recurrence after hospitalization for acute coronary syndrome among HIV‐infected and HIV‐uninfected individuals

“…Findings may also vary over time, as ART for HIV-infected patients has become more lipid-friendly and the incidence of primary MIs in this population has decreased relative to HIV-uninfected individuals [15]. Finally, similar to findings obtained by Calvo-Sanchez et al [28], we found that smoking was a strong predictor of ACS recurrence for HIV-infected but not for HIV-uninfected individuals, highlighting the need for smoking cessation strategies in the HIV-infected patient population. Immunodeficiency has been linked to incident MIs in HIV-infected individuals [9,[29][30][31], including in our own study population [7], an association that may reflect the role of chronic inflammation in the development of atherosclerosis [10].…”

“…Finally, similar to findings obtained by Calvo‐Sanchez et al . , we found that smoking was a strong predictor of ACS recurrence for HIV‐infected but not for HIV‐uninfected individuals, highlighting the need for smoking cessation strategies in the HIV‐infected patient population.…”

Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals

“…Most likely this reflects improved monitoring of lipids and blood pressure in the cohorts rather than any change over time in the risk conferred by these conditions, as well as increased awareness and monitoring of CVD risk and gradual aging of individuals in the cohort, respectively. These findings are consistent with earlier studies [6,15,29,30,31]. The proportion of individuals with an MI who were on ART with a suppressed viral load increased, as did the median CD4 þ cell count.…”

Diabetes Mellitus Type 2 and Abnormal Glucose Metabolism in the Setting of Human Immunodeficiency Virus

“…al. (23) further illustrates these findings. This retrospective chart review utilized two parallel case-controls to evaluate the rate of acute coronary syndrome (ACS) in HIV, with matched populations of HIV-infected patients without ACS, HIV-uninfected patients with ACS, and healthy volunteers.…”