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Mortality With Acute Coronary Syndrome Higher in People With HIV
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18th Conference on Retroviruses and Opportunistic Infections, February 27-March 2, 2011, Boston
"Because people with HIV had worse outcomes after admission for acute coronary syndrome than people without HIV, the researchers believe HIV-positive people need more aggressive screening and management of cardiovascular disease."
Mark Mascolini
HIV-positive people with acute coronary syndrome died more often than HIV-negative people with this diagnosis in a nationwide study, even though the HIV group was 5 years younger and had lower rates of some traditional cardiovascular risk factors [1]. Compared with HIV-negative people, the HIV group was more likely to stay in the hospital more than 10 days.
A large observational study found higher myocardial infarction (MI) rates in people with HIV than in HIV-negative people after statistical adjustment for age, gender, hypertension, diabetes, and abnormal lipids [2]. Another observational study found higher MI rates and hospital admissions for heart disease with HIV than without HIV [3].
The new study analyzed 293,175 hospital admissions for acute coronary syndrome in the Nationwide Inpatient Sample database in 2008 [1]. The Nationwide Inpatient Sample includes data on patients admitted to 1056 hospitals in 42 states, regardless of insurance status. The population for this analysis included 1742 people with HIV infection. Researchers excluded people younger than 30 and older than 65 since everyone with HIV was within this range.
Most people in the sample (82.5%) were men, and most were white (73% without HIV and 52.5% with HIV). People with HIV were significantly more likely to be African American (34% versus 11.6%, P < 0.01). Median age was 50 years in the HIV group and 55 in the HIV-negative group (P < 0.01). Median income was significantly lower in the HIV group.
Prevalence of abnormal lipids was significantly lower in the HIV group (9.2% versus 12.5%, P < 0.01), as was prevalence of diabetes (16.1% versus 26.2%, P < 0.01) and hypertension (55.8% versus 61%, P < 0.01). People with HIV were 3 times more likely to have a history of renal disease (odds ratio [OR] 3.03, P < 0.05), and acute renal failure was more likely in the HIV group (14.9% versus 8.3%, P < 0.01). About half of each group used tobacco.
Length of hospital stay averaged 4.1 days overall and did not differ between the HIV group and the non-HIV group. But a significantly higher proportion of people with HIV stayed in the hospital more than 10 days (P < 0.01). In-hospital mortality was significantly higher in the HIV group: 3.3% versus 2.3% (P < 0.01). The investigators identified seven independent predictors of a hospital stay longer than 10 days or death:
Predictors of hospital stay beyond 10 days
-- Cardiogenic shock: OR 7.6
-- Arrhythmia: OR 4.21
-- Acute renal failure: OR 8.22
-- End-stage renal disease: OR 4.007
Predictors of in-hospital death
-- Percutaneous transluminal coronary angioplasty: OR 6.06
-- Cardiogenic shock: OR 14.55
-- Acute renal failure: OR 12.19
The investigators stressed that the HIV group did worse after admission for acute coronary syndrome even though they were younger and had lower rates of some traditional risk factors than the group without HIV. Although HIV populations often include more smokers than HIV-negative groups, smoking rates were similar with and without HIV in this study.
Because people with HIV had worse outcomes after admission for acute coronary syndrome than people without HIV, the researchers believe HIV-positive people need more aggressive screening and management of cardiovascular disease.
References
1. Lee M, Trivedi P, Tjen-A-Looi A, Hannan L, Kumar P, Timpone J. Mortality and length of stay for HIV+ persons admitted for acute coronary syndrome. 18th Conference on Retroviruses and Opportunistic Infections. February 27-March 2, 2011. Boston. Abstract 801. Poster online at http://www.retroconference.org/2011/PDFs/801.pdf.
2. Triant, VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92:2506-2512.
3. Klein D, Hurley LB, Quesenberry CP Jr, Sidney S. Do protease inhibitors increase the risk for coronary heart disease in patients with HIV-1 infection? JAIDS. 2002;30:471-477.
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