Doubling of CVD mortality risk

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Proportionate CVD mortality more than doubled among HIV-infected adults in the US between 1999 and 2013, according to study findings. Healio reports that Dr Matthew J Feinstein, of Northwestern University Feinberg School of Medicine, and colleagues assessed patterns of CVD mortality for HIV-infected adults in comparison with general and inflammatory polyarthropathy populations using the CDC WONDER online database. All participants were aged 25 years or older.

According to the findings, although total mortality in the HIV-infected population decreased from 15,739 to 8,660 between 1999 and 2013, proportionate CVD mortality increased from 1.95% to 4.62%, particularly in men (P < .0001). During the same period, proportionate CVD mortality decreased for the general and inflammatory polyarthropathy populations. Feinstein and colleagues also reported that for HIV-infected adults, mortality caused by ischemic heart disease tripled from 0.8% in 1999 to 2.5% in 2013. In the general population, however, ischaemic heart disease mortality decreased from 22.8% to 14.6% during the same period.

In addition, the researchers observed that hypertensive heart and renal diseases, as well as pulmonary circulatory diseases, also were common causes of CVD-related death in the HIV-infected population.

“The results of this study underscore the emerging need for enhanced CVD risk prediction and prevention in the HIV-infected population. Traditional (CHD) risk prediction models, such as the Framingham risk score, may provide inadequate discrimination and be poorly calibrated in the HIV-infected population in light of the elevated HIV-related MI risks that may differ from traditional risk factors,” the report says Feinstein and colleagues wrote.

With widespread availability and the use of antiretroviral therapy, patients with human immunodeficiency virus (HIV) in the United States are living long enough to experience non-AIDS–defining illnesses. HIV is associated with an increased risk for cardiovascular disease (CVD) because of traditional CVD risk factors, residual virally mediated inflammation despite HIV treatment, and side effects of antiretroviral therapy. No United States population-wide studies have evaluated patterns of CVD mortality for HIV-infected subjects. Our central hypothesis was that the proportionate mortality from CVD (CVD mortality/total mortality) in the HIV-infected population increased from 1999 to 2013. We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research online database of the United States public health data to assess proportionate CVD mortality from 1999 to 2013 in the HIV-infected, general, and inflammatory polyarthropathy populations; the inflammatory polyarthropathy population was included as a positive control group. Total mortality in the HIV-infected population decreased from 15,739 in 1999 to 8,660 in 2013; however, CVD mortality increased from 307 to 400 during the same period. Thus, proportionate CVD mortality for the HIV-infected population increased significantly from 1999 to 2013 (p <0.0001); this pattern was consistent across races, particularly for men. In contrast, proportionate CVD mortality decreased for the general and inflammatory polyarthropathy populations from 1999 to 2013. In conclusion, CVD has become an increasingly common cause of death in HIV-infected subjects since 1999; understanding evolving mortality risks in the HIV-infected population is essential to inform routine clinical care of HIV-infected subjects as well as CVD prevention and treatment.

Full Healio report
The American Journal of Cardiology abstract

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