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 ( CVD s) 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 CVD s, 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% CI s 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 MI s, 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.