Comparison of risk factors and mortality in veterans with HIV and those without HIV suffering first major acute cardiovascular events.

IF 2.8 3区 医学 Q2 INFECTIOUS DISEASES HIV Medicine Pub Date : 2024-10-27 DOI:10.1111/hiv.13724
William L Hicks, Suzan Khalil, Floyd W Burke, Minh Quang Ho, Ishak Mansi
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Abstract

Background: Previous studies have demonstrated that people with HIV have an increased atherosclerotic plaque vulnerability, making them more susceptible to severe cardiovascular complications. This study aimed to examine the clinical characteristics of people with HIV in comparison to people without HIV admitted to Veterans Health Administration (VHA) with their first major acute cardiovascular events (MACE) and compare their total mortality.

Methods: We used national VHA data to extract data of those admitted to VHA hospitals with MACE defined as acute myocardial infarction (AMI), acute cerebrovascular accident (CVA) or cardiac arrest during the fiscal years 2003-2021. The hazard ratio (HR) of mortality for people with HIV versus people without HIV was estimated using Cox proportional hazard regression analysis.

Results: Out of 280 311 veterans, 2510 people with HIV and 277 801 people without HIV had their first MACE during the study period. People with HIV were younger, more likely to be African American, had a lower prevalence of diabetes mellitus and hypertension, similar total cholesterol levels and a lower mean 10-year cardiovascular risk score (25.4 in people with HIV vs. 28.7 in people without HIV). Among MACE components, people with HIV had a higher proportion of CVA (27% vs. 21.3%, p < 0.001) and cardiac arrest (13.0% vs. 8.4%, p < 0.001) but a lower incidence of AMI (62.4% vs. 72.5%, p < 0.001) than people without HIV. Additionally, people with HIV had a higher risk of total mortality (adjusted HR: 2.05, 95% confidence interval: 1.90-2.22) compared with people without HIV.

Conclusion: People with HIV experience MACE at younger ages despite lower cardiovascular risks and similar baseline cholesterol and blood pressure levels. People with HIV had higher mortality and a higher risk of having ventricular fibrillation arrest and stroke as their first MACE.

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比较首次发生重大急性心血管事件的感染艾滋病毒和未感染艾滋病毒的退伍军人的风险因素和死亡率。
背景:以前的研究表明,艾滋病病毒感染者动脉粥样硬化斑块的易损性增加,使他们更容易出现严重的心血管并发症。本研究旨在考察退伍军人健康管理局(VHA)收治的首次发生重大急性心血管事件(MACE)的艾滋病病毒感染者与非艾滋病病毒感染者的临床特征,并比较他们的总死亡率:我们利用退伍军人健康管理局的全国数据,提取了2003-2021财年期间退伍军人健康管理局医院收治的MACE(定义为急性心肌梗死(AMI)、急性脑血管意外(CVA)或心脏骤停)患者的数据。采用 Cox 比例危险回归分析法估算了 HIV 感染者与非 HIV 感染者的死亡率危险比 (HR):在 280 311 名退伍军人中,有 2510 名艾滋病毒感染者和 277 801 名非艾滋病毒感染者在研究期间发生了首次 MACE。艾滋病病毒感染者更年轻,更可能是非裔美国人,糖尿病和高血压发病率较低,总胆固醇水平相似,10年心血管风险平均得分较低(艾滋病病毒感染者为25.4分,非艾滋病病毒感染者为28.7分)。在 MACE 中,艾滋病病毒感染者发生 CVA 的比例更高(27% 对 21.3%,P 结论:艾滋病病毒感染者发生 MACE 的年龄更小:尽管艾滋病病毒感染者的心血管风险较低,且胆固醇和血压的基线水平相似,但他们发生 MACE 的年龄更小。艾滋病病毒感染者的死亡率较高,室颤停搏和中风作为首次MACE的风险也较高。
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来源期刊
HIV Medicine
HIV Medicine 医学-传染病学
CiteScore
5.10
自引率
10.00%
发文量
167
审稿时长
6-12 weeks
期刊介绍: HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.
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