Secondary prevention strategies are necessary to address adverse outcomes of cardiovascular disease (CVD) among patients with HIV, according to a recent study in JAMA Network Open.1
Takeaways
- Patients with HIV have a higher risk of major cardiovascular events, with studies showing a 2-fold increase compared to those without HIV.
- The increased cardiovascular disease (CVD) risk among HIV patients is linked to traditional CVD factors, aging, and long-term metabolic effects of antiretroviral therapy.
- A meta-analysis of 15 studies involving 9499 HIV patients showed similar rates of acute coronary syndromes (ACS) and coronary revascularization between HIV patients and controls, but higher all-cause mortality and recurrent ACS among HIV patients.
- The study underscores the need for better secondary prevention strategies to manage adverse CVD outcomes in HIV patients, who were found to be less likely to receive statin prescriptions at discharge.
- Further research is recommended to evaluate the effectiveness of aggressive interventions in improving CVD outcomes for patients living with HIV after ACS or percutaneous coronary interventions.
Increased use of antiretroviral therapies (ARTs) has improved rates of survival among people living with HIV, leading to more people with HIV experiencing age-related diseases including CVD. Factors linked to increasing HIV rates include increased burden of traditional CVD factors, increasing age, and long-term metabolic outcomes of ART.
HIV has also been linked to an increased risk of CVD. The Randomized Trial to Prevent Vascular Events in HIV trial reported a 2-fold increase in major cardiovascular event risk among patients with HIV vs those without HIV.2
The earlier incidence of CVD among patients with HIV has led to increased attention toward prevention strategies.1 However, characterization of longitudinal CVD outcomes is needed to identify strategies for secondary prevention.
To evaluate the association between clinical outcomes after acute coronary syndromes (ACS) and percutaneous coronary interventions (PCIs) among patients living with HIV, investigators conducted a systematic review and meta-analysis. Articles were collected from searches of the Ovid MEDLINE, Embase, and Web of Science databases.
Literature was published from database inception to August 2023. Two reviewers performed title and abstract screening, followed by full text screening. Eligibility criteria included patients living with HIV and a control group without HIV, patients with obstructive coronary artery disease and ACS or PCI, and longitudinal follow-up data.
Data extracted included study characteristics, baseline demographic characteristics, other characteristics, HIV-specific characteristics, number of events by group, and hazard ratios (HRs) of clinical outcomes.
There were 15 studies evaluating post-ACS or revascularization outcomes between 2003 and 2023 included in the analysis, including 9499 patients with HIV. The pooled HIV population was aged a mean 56.2 years, and 10.1% were Black, 8.1% Hispanic, and 13.1% White. ACS or coronary revascularization was reported among 21.1% of patients with HIV.
Patients with HIV were often younger than those without HIV, and were more likely to be smokers, engage in illicit drug use, and have higher mean triglyceride and lower mean high-density lipoprotein cholesterol levels. ART was reported among 75.2% of patients with HIV and protease inhibitor therapy among 47.6%.
Similar ST-segment elevation myocardial infarction, non–ST-segment elevation myocardial infarction, and unstable angina were reported between patients with HIV and controls. Rates of PCIs and coronary artery bypass graft surgery were also similar between groups, as well as mean left ventricular ejection fraction values.
The proportion of statin prescription at discharge follow-up was lower among patients with HIV vs controls, at 53.3% and 59.9%, respectively. However, this difference was not considered statistically significant.
The adjusted relative risk (RR) of all-cause mortality for patients with HIV vs controls across a mean 16.2-month follow-up period was 1.64. In comparison, the RR was 1.11 for major adverse cardiovascular event, 1.83 for recurrent ACS, 3.39 for heart failure readmission, and 2.40 for restenosis.
Pooled HRs did not significantly differ for CV death, total vessel revascularization, or total lesion revascularization. Low heterogeneity across studies was reported for most outcomes.
These results indicated a need for optimization of secondary prevention strategies for managing adverse CVD outcomes among patients with HIV. Investigators recommended further research evaluate the role of aggressive interventions among patients living with HIV after ACS or PCI.
References
- Haji M, Capilupi M, Kwok M, et al. Clinical outcomes after acute coronary syndromes or revascularization among people living with HIV: A systematic review and meta-analysis. JAMA Netw Open. 2024;7(5):e2411159. doi:10.1001/jamanetworkopen.2024.11159
- Krewson C. HIV linked to elevated cardiovascular disease risk. Contemporary OB/GYN. March 4, 2024. Accessed May 28, 2024. https://www.contemporaryobgyn.net/view/hiv-linked-to-elevated-cardiovascular-disease-risk
