Jessica R White1, Chung-Chou H Chang1, Kaku A So-Armah1, Jesse C Stewart1, Samir K Gupta1, Adeel A Butt1, Cynthia L Gibert1, David Rimland1, Maria C Rodriguez-Barradas1, David A Leaf1, Roger J Bedimo1, John S Gottdiener1, Willem J Kop1, Stephen S Gottlieb1, Matthew J Budoff1, Tasneem Khambaty1, Hilary A Tindle1, Amy C Justice1, Matthew S Freiberg2. 1. From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.). 2. From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.). matthew.s.freiberg@vanderbilt.edu.
Abstract
BACKGROUND: Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF. METHODS AND RESULTS: Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (n=81 427: 26 908 HIV+, 54 519 without HIV [HIV-]) were categorized into 4 groups: HIV- without major depressive disorder (MDD) [reference], HIV- with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% confidence interval [CI], 8.20-10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95% CI, 1.45-1.95) compared with HIV- participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV- and HIV+ participants (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.37; and adjusted hazard ratio, 1.29; 95% CI, 1.11-1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95% CI, 0.58-0.99). CONCLUSIONS: Our study is the first to suggest that MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.
BACKGROUND: Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF. METHODS AND RESULTS: Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (n=81 427: 26 908 HIV+, 54 519 without HIV [HIV-]) were categorized into 4 groups: HIV- without major depressive disorder (MDD) [reference], HIV- with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% confidence interval [CI], 8.20-10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95% CI, 1.45-1.95) compared with HIV- participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV- and HIV+ participants (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.37; and adjusted hazard ratio, 1.29; 95% CI, 1.11-1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95% CI, 0.58-0.99). CONCLUSIONS: Our study is the first to suggest that MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.
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