HIV Infection and Incidence of Cardiovascular Diseases: An Analysis of a Large Healthcare Database

Background-People living with HIV (PLWH) experience higher risk of myocardial infarction (MI) and heart failure (HF) compared with uninfected individuals. Risk of other cardiovascular diseases (CVDs) in PLWH has received less attention. Methods and Results-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 to 2015. Incidence of CVDs, including MI, HF, atrial fibrillation, peripheral artery disease, stroke and any CVD-related hospitalization, were identified using validated algorithms. We used adjusted Cox models to estimate hazard ratios and 95% CIs of CVD end points and performed probabilistic bias analysis to control for unmeasured confounding by race. After a mean follow-up of 20 months, patients experienced 154 MIs, 223 HF, 93 stroke, 397 atrial fibrillation, 98 peripheral artery disease, and 935 CVD hospitalizations (rates per 1000 person-years: 1.2, 1.7, 0.7, 3.0, 0.8, and 7.1, respectively). Hazard ratios (95% CI) comparing PLWH with 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 atrial fibrillation, 1.1 (0.7-1.7) for peripheral artery disease, and 1.7 (1.5-2.0) for any CVD 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 atrial fibrillation, 0.9 [0.5-1.4] for peripheral artery disease, and 1.6 [1.3-1.9] for CVD hospitalization). Conclusions-In a large health insurance database, 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.