Shreya G Rao1, Karla I Galaviz2, Hawkins C Gay3, Jingkai Wei4, Wendy S Armstrong5, Carlos Del Rio2,6, K M Venkat Narayan2, Mohammed K Ali2. 1. Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX. 2. Hubert Department of Global Health, Emory University, Atlanta, GA. 3. Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL. 4. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC. 5. Department of Medicine, Emory University School of Medicine and Emory Center for AIDS Research, Atlanta, GA. 6. Department of Medicine and Emory Center for AIDS Research, Emory University, Atlanta, GA.
Abstract
OBJECTIVES: To estimate the pooled relative risk (RR) of incident acute myocardial infarction (AMI) among HIV-infected adults compared with HIV-uninfected controls and explore the contribution of traditional and HIV-related risk factors. BACKGROUND: Understanding AMI risk and associated risk factors in HIV-infected populations has the potential to inform clinical management and prevention strategies. METHODS: We systematically identified cohort studies of HIV-infected or HIV-infected and matched uninfected adults reporting AMI incidence rates published up to January 1, 2017. Random-effects meta-analysis models were used to estimate the aggregate RR of AMI by HIV status. Subgroup analysis and meta-regression were used to explore factors affecting risk. RESULTS: Sixteen studies (N = 1,619,690, median age 38.5 years, 78.9% male, mean follow-up of 6.5 years) were included. In pooled analyses of HIV-infected and matched uninfected cohorts (n = 5), HIV-infected individuals had higher AMI incidence rates (absolute risk difference = 2.2 cases per 1000 persons per year) and twice the risk of AMI [RR = 1.96 (1.5-2.6)] compared with matched HIV-uninfected controls. In a multivariate meta-regression, each additional percentage point in the proportion of male participants [odds ratio (OR) = 1.20 (1.14-1.27)] and each additional percentage point in the prevalence of hypertension [OR = 1.19 (1.12-1.27)], dyslipidemia [OR = 1.09 (1.07-1.11)], and smoking [OR = 1.09 (1.05-1.13)] were independently associated with increased AMI risk in HIV-infected adults. CONCLUSIONS AND RELEVANCE: Chronic HIV infection is associated with a 2-fold higher AMI risk. Traditional risk factors such as hypertension, dyslipidemia, and smoking are significant contributors to AMI risk among HIV-infected adults and should be aggressively targeted in routine HIV care.
OBJECTIVES: To estimate the pooled relative risk (RR) of incident acute myocardial infarction (AMI) among HIV-infected adults compared with HIV-uninfected controls and explore the contribution of traditional and HIV-related risk factors. BACKGROUND: Understanding AMI risk and associated risk factors in HIV-infected populations has the potential to inform clinical management and prevention strategies. METHODS: We systematically identified cohort studies of HIV-infected or HIV-infected and matched uninfected adults reporting AMI incidence rates published up to January 1, 2017. Random-effects meta-analysis models were used to estimate the aggregate RR of AMI by HIV status. Subgroup analysis and meta-regression were used to explore factors affecting risk. RESULTS: Sixteen studies (N = 1,619,690, median age 38.5 years, 78.9% male, mean follow-up of 6.5 years) were included. In pooled analyses of HIV-infected and matched uninfected cohorts (n = 5), HIV-infected individuals had higher AMI incidence rates (absolute risk difference = 2.2 cases per 1000 persons per year) and twice the risk of AMI [RR = 1.96 (1.5-2.6)] compared with matched HIV-uninfected controls. In a multivariate meta-regression, each additional percentage point in the proportion of male participants [odds ratio (OR) = 1.20 (1.14-1.27)] and each additional percentage point in the prevalence of hypertension [OR = 1.19 (1.12-1.27)], dyslipidemia [OR = 1.09 (1.07-1.11)], and smoking [OR = 1.09 (1.05-1.13)] were independently associated with increased AMI risk in HIV-infected adults. CONCLUSIONS AND RELEVANCE: Chronic HIV infection is associated with a 2-fold higher AMI risk. Traditional risk factors such as hypertension, dyslipidemia, and smoking are significant contributors to AMI risk among HIV-infected adults and should be aggressively targeted in routine HIV care.
Authors: Grace P S Kwong; Azra C Ghani; Richard A Rode; Lucy M Bartley; Benjamin J Cowling; Barbara da Silva; Christl A Donnelly; Ard I van Sighem; D William Cameron; Sven A Danner; Frank de Wolf; Roy M Anderson Journal: AIDS Date: 2006-10-03 Impact factor: 4.177
Authors: Virginia A Triant; Susan Regan; Hang Lee; Paul E Sax; James B Meigs; Steven K Grinspoon Journal: J Acquir Immune Defic Syndr Date: 2010-12-15 Impact factor: 3.731
Authors: Matthew S Freiberg; Chung-Chou H Chang; Lewis H Kuller; Melissa Skanderson; Elliott Lowy; Kevin L Kraemer; Adeel A Butt; Matthew Bidwell Goetz; David Leaf; Kris Ann Oursler; David Rimland; Maria Rodriguez Barradas; Sheldon Brown; Cynthia Gibert; Kathy McGinnis; Kristina Crothers; Jason Sico; Heidi Crane; Alberta Warner; Stephen Gottlieb; John Gottdiener; Russell P Tracy; Matthew Budoff; Courtney Watson; Kaku A Armah; Donna Doebler; Kendall Bryant; Amy C Justice Journal: JAMA Intern Med Date: 2013-04-22 Impact factor: 21.873
Authors: Keri N Althoff; Kathleen A McGinnis; Christina M Wyatt; Matthew S Freiberg; Cynthia Gilbert; Krisann K Oursler; David Rimland; Maria C Rodriguez-Barradas; Robert Dubrow; Lesley S Park; Melissa Skanderson; Meredith S Shiels; Stephen J Gange; Kelly A Gebo; Amy C Justice Journal: Clin Infect Dis Date: 2014-10-30 Impact factor: 9.079
Authors: Joanne Reekie; Justyna D Kowalska; Igor Karpov; Jurgen Rockstroh; Anders Karlsson; Aza Rakhmanova; Andrzej Horban; Ole Kirk; Jens D Lundgren; Amanda Mocroft Journal: PLoS One Date: 2012-07-23 Impact factor: 3.240
Authors: Clay Bavinger; Eran Bendavid; Katherine Niehaus; Richard A Olshen; Ingram Olkin; Vandana Sundaram; Nicole Wein; Mark Holodniy; Nanjiang Hou; Douglas K Owens; Manisha Desai Journal: PLoS One Date: 2013-03-26 Impact factor: 3.240
Authors: Michael H Chung; Anoop Sv Shah; Hassan Adan Ahmed; Jeilan Mohamed; Isaiah G Akuku; Kuan Ken Lee; Shirjel R Alam; Pablo Perel; Jasmit Shah; Mohammed K Ali; Sherry Eskander Journal: BMJ Open Date: 2022-06-06 Impact factor: 3.006
Authors: Mandana Khalili; Wendy C King; David E Kleiner; Mamta K Jain; Raymond T Chung; Mark Sulkowski; Mauricio Lisker-Melman; David K Wong; Marc Ghany; Arun Sanyal; Richard K Sterling Journal: Clin Infect Dis Date: 2021-11-02 Impact factor: 20.999
Authors: Nathan A Summers; Cecile D Lahiri; Christine D Angert; Amalia Aldredge; C Christina Mehta; Ighovwerha Ofotokun; Anne M Kerchberger; Deborah Gustafson; Sheri D Weiser; Seble Kassaye; Deborah Konkle-Parker; Anjali Sharma; Adaora A Adimora; Hector Bolivar; Jennifer Cocohoba; Audrey L French; Elizabeth T Golub; Anandi N Sheth Journal: J Acquir Immune Defic Syndr Date: 2020-11-01 Impact factor: 3.771