HIV-infected adults with MDD face higher heart attack risk

Organisation: Position: Deadline Date: Location:

Among more than 26,000 human immunodeficiency virus (HIV)-infected adults, those with major depressive disorder (MDD) were more likely to experience a heart attack than those without MDD, according to a new study.

With the advent of highly effective antiretroviral therapy and improved survival, people with HIV-infection are living longer and are now at an increased risk for cardiovascular disease (CVD). There is an urgent need to identify novel risk factors and primary prevention approaches for CVD in HIV. Although depression is prevalent in HIV-infected adults and is associated with future CVD in the general population, its association with CVD events has not been examined in the HIV-infected population.

Dr Matthew S Freiberg, of the Vanderbilt University School of Medicine, Nashville, and colleagues conducted a study that included 26,144 HIV-infected veterans without CVD at baseline (1998-2003) participating in the US Department of Veterans Affairs, Veterans Aging Cohort Study from April 2003 through December 2009. At study entry, 4,853 veterans (19%) with major depressive disorder were identified.

The average age of those with MDD was 47 years and for those without MDD was 48 years. During 5.8 years of follow-up, 490 acute myocardial infarction (AMI; heart attack) events occurred. After adjustment for demographics, CVD risk factors, and HIV-specific factors, the researchers found that HIV-infected adults with MDD had a 30% greater risk for having an AMI than did HIV-infected adults without MDD. This elevation in AMI risk was slightly lessened to 25% after further adjustment for other variables, such as hepatitis C infection, kidney disease, alcohol/cocaine abuse or dependence, and haemoglobin levels.

“Our findings raise the possibility that, similar to the general population, MDD may be independently associated with incident atherosclerotic CVD in the HIV-infected population. Considering the dearth of research in this area, future epidemiologic and mechanistic studies that include women and non-VA populations with HIV are needed,” the authors write.

Abstract
Importance: With the advent of highly effective antiretroviral therapy and improved survival, human immunodeficiency virus (HIV)–infected people are living longer and are now at an increased risk for cardiovascular disease (CVD). There is an urgent need to identify novel risk factors and primary prevention approaches for CVD in HIV. Although depression is prevalent in HIV-infected adults and is associated with future CVD in the general population, its association with CVD events has not been examined in the HIV-infected population.
Objective: To examine whether depressive disorders are prospectively associated with incident acute myocardial infarction (AMI) in a large cohort of adults with HIV.
Design, Setting, and Participants: Included in this cohort study were 26 144 HIV-infected veterans without CVD at baseline (1998-2003) participating in the US Department of Veterans Affairs Veterans Aging Cohort Study from April 1, 2003, through December 31, 2009. At baseline, 4853 veterans (19%) with major depressive disorder (MDD; International Classification of Diseases, Ninth Revision [ICD-9] codes 296.2 and 296.3) and 2296 (9%) with dysthymic disorder (ICD-9 code 300.4) were identified. The current analysis was conducted from January 2015 to November 2015.
Main Outcomes and Measures: Incident AMI (defined by discharge summary documentation, enzyme/electrocardiography evidence of AMI, inpatient ICD-9 code for AMI (410), or AMI as underlying cause of death [International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code 121]) between the enrollment date and December 31, 2009.
Results: The mean (SD) age of those with MDD was 47.3 (7.9) years and for those without MDD was 48.2 (9.7) years. During 5.8 years of follow-up, 490 AMI events (1.9%) occurred. Baseline MDD was associated with incident AMI after adjusting for demographics (hazard ratio [HR], 1.31; 95% CI, 1.05-1.62), CVD risk factors (HR, 1.29; 95% CI, 1.04-1.60), and HIV-specific factors (HR, 1.30; 95% CI, 1.05-1.62). Further adjustment for hepatitis C, renal disease, substance abuse, and hemoglobin level (HR, 1.25; 95% CI, 1.00-1.56) and antidepressant use (HR, 1.12; 95% CI, 0.87-1.42) attenuated associations. Baseline dysthymic disorder was not associated with incident AMI.
Conclusions and Relevance: We report novel evidence that HIV-infected adults with MDD have a 30% increased risk for AMI than HIV-infected adults without MDD after adjustment for many potential confounders. Our findings raise the possibility that MDD may be independently associated with incident atherosclerotic CVD in the HIV-infected population.

Authors
Tasneem Khambaty; Jesse C Stewart; Samir K Gupta; Chung-Chou H Chang; Roger J Bedimo; Matthew J Budoff; Adeel A Butt; Heidi Crane; Cynthia L Gibert; David A Leaf; David Rimland; Hilary A Tindle; Kaku A So-Armah; Amy C Justice; Matthew S Freiberg

JAMA material
JAMA Cardiology abstract


Receive Medical Brief's free weekly e-newsletter



Related Posts

Thank you for subscribing to MedicalBrief


MedicalBrief is Africa’s premier medical news and research weekly newsletter. MedicalBrief is published every Thursday and delivered free of charge by email to over 33 000 health professionals.

Please consider completing the form below. The information you supply is optional and will only be used to compile a demographic profile of our subscribers. Your personal details will never be shared with a third party.


Thank you for taking the time to complete the form.