Depression Increases Risk of Acute MI by 30% in HIV-Positive Patients

In patients who are HIV positive, depression may play a role in development of cardiovascular disease (CVD), a Veterans Affairs study suggests. The findings illustrate the sea change that has occurred with regard to tracking and addressing health problems in these patients, who are living longer as a result of ongoing improvements in therapy. 

“In many parts of the world, HIV has almost transitioned to a chronic disease,” the study’s senior author Matthew S. Freiberg, MD, MSc (Vanderbilt University School of Medicine, Nashville, TN), told TCTMD in an interview. Helping clinicians to think about HIV-infected patients beyond their virus-related health issues, he added, is crucial to continuing to make strides in their care.

He hopes the message from this study sinks in for physicians treating HIV-positive patients. “If depression even crosses their mind for two seconds . . . then this paper has achieved its job,” he said. “Our goal is to get clinicians to be as thoughtful as possible with this patient population in helping them prevent heart disease.”

The study, published online August 24, 2016, ahead of print in JAMA Cardiology and led by Tasneem Khambaty, PhD (University of Miami, Coral Gables, FL), focused on 26,144 HIV-infected individuals enrolled in the Veterans Aging Cohort Study from 1998 to 2003 and followed through 2009. None had CVD at baseline, but 19% had major depressive disorder and 9% had dysthymic disorder.

Over a mean follow-up of 5.8 years, those with depression had a 30% greater risk of acute MI than those without depression, even after adjustment for demographics, risk factors for CVD, and HIV-specific factors.

To TCTMD, Freiberg said the VA cohort provides a unique opportunity to follow a large number of HIV-infected individuals living long enough with the virus to encounter other health-related issues that require attention and research.

“We were learning early on in the epidemic that there might be non-AIDS diseases that also are facing these people—things like diabetes, and cancer and heart disease—but there were never large enough samples to make it epidemiologically sound to look at those issues,” he observed. “Our focus was simply on how do we keep people alive when they have HIV.”

The virus itself can play a role in increasing a person’s CVD risk as a result of chronic inflammation, effects of antiretrovirals, cormorbid diseases often “carried” with HIV, and inadequate quality of health care, in some cases.

But Freiberg noted that depression has been considered a risk factor for CVD in the general population for quite some time and that if the finding in HIV-infected patients is real, it deserves further study focused on diagnosis and treatment of depression as a primary prevention effort for CVD. For HIV patients, that may be especially important to prevent the more complex problems of polypharmacy that can arise if serious CVD develops. The VA study included almost exclusively men, however, so it will be important to look at the issue in HIV-infected women as well, he added.

Disclosures:

• The Veterans Aging Cohort Study was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism and Veterans Health Administration Public Health Strategic Health Core Group. 
• Khambaty and Freiberg report no relevant conflicts of interest. 

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