April 18, 2016
From 1999 through 2013, the proportion of all deaths caused by cardiovascular disease (CVD) rose more than two-fold in a population-wide analysis of HIV-positive people across the United States. That increase held true across races.
CVD poses a greater threat to people with than without HIV because of high rates of traditional CVD risk factors in the HIV population, persistent inflammation despite antiretroviral therapy and antiretroviral side effects. A team of HIV-CVD experts conducted this analysis because no population-wide U.S. analysis had assessed proportionate mortality from CVD in people with HIV, that is, the proportion of all deaths caused by CVD.
To explore causes of death across the United States from 1999 through 2013, the researchers used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database, which captures demographic data and mortality from death certificates for all in-hospital and out-of-hospital deaths in U.S. residents. The study aimed to compare proportionate CVD mortality in three groups: people with HIV infection, people with inflammatory polyarthropathy (a positive control group) and the general population. The analysis included only people 25 or older at the time of death.
Compared with people dying of CVD in the general population, HIV patients dying of CVD were more likely to be men (77% versus 48%), black (52% versus 12%), and younger (18% versus 2% 35 to 44, 36% versus 5% 45 to 54 and 27% versus 10% 55 to 64). Among people with HIV, CVD accounted for 307 deaths in 1999 and 400 deaths in 2013. In those same years, total deaths among people with HIV fell from 15,739 to 8660.
Proportionate CVD mortality among people with HIV climbed from 1.95% in 1999 to 4.62% in 2013, a 2.4-fold increase. In contrast, over the same years proportionate CVD mortality in the general U.S. population and in the inflammatory polyarthropathy population fell from about 40% to 30% in both groups. Among people with HIV infection, the rising proportionate CVD mortality was statistically significant for both men (β = 0.0022, P < .0001) and women (β = 0.0011, P = .0028) and was consistent across all race-gender groups.
In a sensitivity analysis focused solely on in-hospital deaths, proportionate CVD mortality also rose in the HIV group while falling in the general population from 1999 through 2013. In another sensitivity analysis, proportionate ischemic heart disease mortality climbed from 0.8% in 1999 to 2.5% in 2013 among people with HIV while falling from 22.8% in 1999 to 14.6% in 2013 in the general population.
The researchers believe the rising proportionate CVD mortality among U.S. residents with HIV is "not surprising given their decreasing competing risks for AIDS-related mortality in recent years, their elevated risks for CVD, and the overall aging of the U.S. HIV population." The authors argue that their findings "underscore the emerging need for enhanced CVD risk prediction and prevention in the HIV-infected population."
Mark Mascolini writes about HIV infection.
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