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Submitted on October 6, 2006
Accepted on April 12, 2007
Massachusetts General Hospital (MGH) Program in Nutritional Metabolism (V.T., C.H. and S.G.), Brigham and Women's Hospital (BWH) and MGH Divisions of Infectious Diseases (V.T.) and the MGH Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
* To whom correspondence should be addressed. E-mail: sgrinspoon{at}partners.org.
Context: Metabolic changes and smoking are common among HIV patients and may confer increased cardiovascular risk.
Objective: To determine acute myocardial infarction (AMI) rates and cardiovascular risk factors in HIV compared to non-HIV patients in two tertiary care hospitals.
Design, Setting and Participants: We conducted a health-care system-based cohort study using a large data registry with 3,851 HIV and 1,044,589 non-HIV patients. AMI rates were determined among patients receiving longitudinal care between October 1, 1996 and June 30, 2004.
Main Outcome Measures: The primary outcome was myocardial infarction, identified by International Classification of Diseases coding criteria.
Results: AMI was identified in 189 HIV and in 26,142 non-HIV patients. AMI rates per 1000 person years were increased in HIV versus non-HIV patients (11.13 [95% CI 9.58-12.68] vs. 6.98 [95% CI 6.89-7.06]). The HIV cohort had significantly higher proportions of hypertension (21.2 vs. 15.9 percent), diabetes (11.5 vs. 6.6 percent), and dyslipidemia (23.3 vs. 17.6 percent) than the non-HIV cohort (P<0.0001 for each comparison). The difference in AMI rates between HIV and non-HIV patients was significant, with a relative risk (RR) of 1.75 (95% CI 1.51-2.02; P<0.0001), adjusting for age, gender, race, hypertension, diabetes, and dyslipidemia. In gender-stratified models, the unadjusted AMI rates per 1000 person years were higher for HIV patients among women (12.71 vs. 4.88 for HIV compared to non-HIV women) but not among men (10.48 vs. 11.44 for HIV compared to non-HIV men). The relative risks were 2.98 (95% CI 2.33-3.75; P<0.0001) for women and 1.40 (95% CI 1.16-1.67; P=0.0003) for men, adjusting for age, gender, race, hypertension, diabetes, and dyslipidemia. A limitation of this database is that it contains incomplete data on smoking. Smoking could not be included in the overall regression model and some of the increased risk may be accounted for by differences in smoking rates.
Conclusions: AMI rates and cardiovascular risk factors were increased in HIV compared to non-HIV patients, particularly among women. Cardiac risk modification strategies are important for the long-term care of HIV patients.
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