Increased Risk of CVD With Age in HIV-Positive Men
Increased Risk of CVD With Age in HIV-Positive Men
Objectives The aim of the study was to statistically model the relative increased risk of cardiovascular disease (CVD) per year older in Data collection on Adverse events of anti-HIV Drugs (D:A:D) and to compare this with the relative increased risk of CVD per year older in general population risk equations.
Methods We analysed three endpoints: myocardial infarction (MI), coronary heart disease (CHD: MI or invasive coronary procedure) and CVD (CHD or stroke). We fitted a number of parametric age effects, adjusting for known risk factors and antiretroviral therapy (ART) use. The best-fitting age effect was determined using the Akaike information criterion. We compared the ageing effect from D:A:D with that from the general population risk equations: the Framingham Heart Study, CUORE and ASSIGN risk scores.
Results A total of 24 323 men were included in analyses. Crude MI, CHD and CVD event rates per 1000 person-years increased from 2.29, 3.11 and 3.65 in those aged 40–45 years to 6.53, 11.91 and 15.89 in those aged 60–65 years, respectively. The best-fitting models included inverse age for MI and age + age for CHD and CVD. In D:A:D there was a slowly accelerating increased risk of CHD and CVD per year older, which appeared to be only modest yet was consistently raised compared with the risk in the general population. The relative risk of MI with age was not different between D:A:D and the general population.
Conclusions We found only limited evidence of accelerating increased risk of CVD with age in D:A:D compared with the general population. The absolute risk of CVD associated with HIV infection remains uncertain.
Successfully treated HIV-positive people remain at increased risk of a number of age-related non-AIDS morbidities, such as cardiovascular disease (CVD), cancer, and liver and kidney diseases. A number of studies suggest that these complications occur at a higher rate among HIV-positive patients compared with general populations. HIV-positive persons have also been reported to experience greater multimorbidity than general populations. Careful interpretation of these studies is required as the comparisons are often with unmatched HIV-negative populations, or population based, or retrospective in nature, probably resulting in unmeasured confounding.
CVD events in HIV-positive patients have been reported to occur at higher rates compared with HIV-negative or general populations of similar age. Triant et al. demonstrated not only a consistently higher rate of myocardial infarction (MI) for all age groups in HIV-positive compared with HIV-negative persons, but that the difference in rates between HIV-positive and HIV-negative persons also increased with age. Currier et al. demonstrated increased rates of CVD in HIV-positive compared with HIV-negative persons in the younger age groups of 18–34 years in men and up to 44 years in women. Yet, by age ≥65 years, rates were higher in HIV-negative people, probably as a result of HIV-positive individuals dying earlier. Rates of MI, for instance, have been reported in various studies to range from 1.11 to 3.5 per 1000 person-years among HIV-positive patients. However, the risk of CVD in HIV-positive people is influenced not only by the traditional cardiovascular risk factors, which are highly prevalent in this now ageing population, genetics and family history, but also by the effect of antiretroviral therapy (ART), and the effect of HIV itself. It is well known that the risk of CVD increases with age, yet it remains unclear whether this age-related increase is more rapid in HIV-positive people than in the general HIV-negative population. Results to date have primarily relied on comparisons with general populations. Some comparisons matched for age and sex, but not many for the remaining risks factors, in particular smoking.
We hypothesized that, if the risk of CVD increases faster with age in HIV-positive people, then we would expect the relative increased risk of CVD events per year older to be higher in Data collection on Adverse events of anti-HIV drugs (D:A:D) than in the general population. The objective of this study therefore was to statistically model in detail the relative increased risk of CVD per year older in D:A:D and to compare this with the relative increased risk of CVD per year older in the general population risk equations.
Abstract and Introduction
Abstract
Objectives The aim of the study was to statistically model the relative increased risk of cardiovascular disease (CVD) per year older in Data collection on Adverse events of anti-HIV Drugs (D:A:D) and to compare this with the relative increased risk of CVD per year older in general population risk equations.
Methods We analysed three endpoints: myocardial infarction (MI), coronary heart disease (CHD: MI or invasive coronary procedure) and CVD (CHD or stroke). We fitted a number of parametric age effects, adjusting for known risk factors and antiretroviral therapy (ART) use. The best-fitting age effect was determined using the Akaike information criterion. We compared the ageing effect from D:A:D with that from the general population risk equations: the Framingham Heart Study, CUORE and ASSIGN risk scores.
Results A total of 24 323 men were included in analyses. Crude MI, CHD and CVD event rates per 1000 person-years increased from 2.29, 3.11 and 3.65 in those aged 40–45 years to 6.53, 11.91 and 15.89 in those aged 60–65 years, respectively. The best-fitting models included inverse age for MI and age + age for CHD and CVD. In D:A:D there was a slowly accelerating increased risk of CHD and CVD per year older, which appeared to be only modest yet was consistently raised compared with the risk in the general population. The relative risk of MI with age was not different between D:A:D and the general population.
Conclusions We found only limited evidence of accelerating increased risk of CVD with age in D:A:D compared with the general population. The absolute risk of CVD associated with HIV infection remains uncertain.
Introduction
Successfully treated HIV-positive people remain at increased risk of a number of age-related non-AIDS morbidities, such as cardiovascular disease (CVD), cancer, and liver and kidney diseases. A number of studies suggest that these complications occur at a higher rate among HIV-positive patients compared with general populations. HIV-positive persons have also been reported to experience greater multimorbidity than general populations. Careful interpretation of these studies is required as the comparisons are often with unmatched HIV-negative populations, or population based, or retrospective in nature, probably resulting in unmeasured confounding.
CVD events in HIV-positive patients have been reported to occur at higher rates compared with HIV-negative or general populations of similar age. Triant et al. demonstrated not only a consistently higher rate of myocardial infarction (MI) for all age groups in HIV-positive compared with HIV-negative persons, but that the difference in rates between HIV-positive and HIV-negative persons also increased with age. Currier et al. demonstrated increased rates of CVD in HIV-positive compared with HIV-negative persons in the younger age groups of 18–34 years in men and up to 44 years in women. Yet, by age ≥65 years, rates were higher in HIV-negative people, probably as a result of HIV-positive individuals dying earlier. Rates of MI, for instance, have been reported in various studies to range from 1.11 to 3.5 per 1000 person-years among HIV-positive patients. However, the risk of CVD in HIV-positive people is influenced not only by the traditional cardiovascular risk factors, which are highly prevalent in this now ageing population, genetics and family history, but also by the effect of antiretroviral therapy (ART), and the effect of HIV itself. It is well known that the risk of CVD increases with age, yet it remains unclear whether this age-related increase is more rapid in HIV-positive people than in the general HIV-negative population. Results to date have primarily relied on comparisons with general populations. Some comparisons matched for age and sex, but not many for the remaining risks factors, in particular smoking.
We hypothesized that, if the risk of CVD increases faster with age in HIV-positive people, then we would expect the relative increased risk of CVD events per year older to be higher in Data collection on Adverse events of anti-HIV drugs (D:A:D) than in the general population. The objective of this study therefore was to statistically model in detail the relative increased risk of CVD per year older in D:A:D and to compare this with the relative increased risk of CVD per year older in the general population risk equations.