Acute Myocardial Infarction Rates Among Patients with HIV Disease

1
Acute Myocardial Infarction Rates Among Patients
with HIV Disease Virginia Triant, MD, MPH, Hang
Lee, PhD, Colleen Hadigan, MD, MPH, and Steven
Grinspoon, MD Program in Nutritional Metabolism,
Division of Infectious Diseases, and
Biostatistics Center Massachusetts General
Hospital and Brigham and Womens Hospital,
Boston, MA USA

• Introduction
• Cardiac risk factors are common among HIV
  patients.
• It is not known whether acute myocardial
  infarction (AMI) rates are increased among HIV
  patients compared to non-HIV patients.
• Whether HIV is an independent risk factor for
  AMI has not been determined.

Myocardial Infarction Rates Using ICD Coding
(right). Gray bars HIV. White bars non-HIV.
Odds ratios are adjusted.
Myocardial Infarction Rates Using ICD Coding
(Panels A, B, C) or Cardiac Enzyme (Panels D, E,
F) (above). Gray lines HIV. Black lines
non-HIV. Panels A and D all. Panels B and E
females. Panels C and F males.

• Methods
• Cohort study of 4,001 HIV and 1,319,001 non-HIV
  patients
• Brigham and Womens Hospital or Massachusetts
  General Hospital
• October 1, 1996 to June 30, 2004
• Primary outcome was AMI, identified by ICD
  coding and cardiac enzyme criteria
• Odds ratios for AMI obtained using multivariate
  logistic regression modeling

• Results
• AMI rate for HIV was 5.37 (95 CI 4.67-6.07) and
  for non-HIV was 3.05 (95 CI 3.02-3.08) per 100
  persons using ICD criteria.
• Odds ratio (OR) for AMI was 1.77 (95 CI
  1.52-2.05 Plt0.0001) in a model adjusted for age,
  gender, race, hypertension, diabetes and
  dyslipidemia.
• Using cardiac enzyme criteria, AMI rates were
  6.45 (95 CI 5.69-7.21) for HIV and 3.41 (95 CI
  3.38-3.44) for non-HIV per 100 persons. Adjusted
  OR was 2.17 (95 CI 1.89-2.48 Plt0.0001).

• Conclusions
• AMI rates are increased among HIV patients
  compared with non-HIV patients, and HIV is an
  independent risk factor for AMI.
• The increase in AMI rates is demonstrated across
  all age groups and for both genders.
• The difference in AMI rates is more pronounced
  among women.
• As antiretroviral treatment programs continue to
  expand and more patients are living longer with
  HIV globally, monitoring and treating long-term
  complications such as cardiovascular disease will
  be critical components of HIV care.

Risk Factors for Myocardial Infarction (above).
Data are from multivariate Poisson regression
model.
Contact Virginia Triant at vtriant_at_partners.org