HIV infection and incidence of cardiovascular diseases: an analysis of a large healthcare database

Background: Persons living with HIV (PLWH) experience higher risk of cardiovascular diseases (CVD) such as myocardial infarction (MI) and heart failure (HF) compared to uninfected individuals. Risk of other CVDs in PLWH has received less attention. Methods: We studied 19,798 PLWH and 59,302 age and sex-matched uninfected individuals identified from the MarketScan Commercial and Medicare databases in the period 2009-2015. Incidence of CVDs, including MI, HF, atrial fibrillation (AF), peripheral artery disease (PAD), stroke and any CVD-related hospitalization, were identified using validated algorithms. We used adjusted Cox models to estimate hazard ratios (HR) and 95% confidence interval (95%CI) of CVD endpoints and performed probabilistic bias analysis to control for unmeasured confounding by race. Results: After a mean (median) follow-up of 20 (17) months, study patients experienced 154 MIs, 223 HF, 93 stroke, 397 AF, 98 PAD and 935 CVD hospitalizations. HR (95%CI) comparing PLWH to uninfected controls were 1.3 (0.9, 1.9) for MI, 3.2 (2.4, 4.2) for HF, 2.7 (1.7, 4.0) for stroke, 1.2 (1.0, 1.5) for AF, 1.1 (0.7, 1.7) for PAD, and 1.7 (1.5, 2.0) for any CVD-related hospitalization. Adjustment for unmeasured confounding led to similar associations [1.2 (0.8, 1.8) for MI, 2.8 (2.0, 3.8) for HF, 2.3 (1.5, 3.6) for stroke, 1.3 (1.0, 1.7) for AF, 0.9 (0.5, 1.4) for PAD, and 1.6 (1.3, 1.9) for CVD hospitalization]. Conclusion: Using a large health insurance database, we showed that PLWH have an elevated risk of CVD, particularly HF and stroke. With the aging of the HIV population, developing interventions for cardiovascular health promotion and CVD prevention is imperative.