Coronary Artery Disease
Patterns of Cardiovascular Mortality for HIV-Infected Adults in the United States: 1999 to 2013

https://doi.org/10.1016/j.amjcard.2015.10.030Get rights and content

With widespread availability and the use of antiretroviral therapy, patients with human immunodeficiency virus (HIV) in the United States are living long enough to experience non-AIDS–defining illnesses. HIV is associated with an increased risk for cardiovascular disease (CVD) because of traditional CVD risk factors, residual virally mediated inflammation despite HIV treatment, and side effects of antiretroviral therapy. No United States population-wide studies have evaluated patterns of CVD mortality for HIV-infected subjects. Our central hypothesis was that the proportionate mortality from CVD (CVD mortality/total mortality) in the HIV-infected population increased from 1999 to 2013. We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research online database of the United States public health data to assess proportionate CVD mortality from 1999 to 2013 in the HIV-infected, general, and inflammatory polyarthropathy populations; the inflammatory polyarthropathy population was included as a positive control group. Total mortality in the HIV-infected population decreased from 15,739 in 1999 to 8,660 in 2013; however, CVD mortality increased from 307 to 400 during the same period. Thus, proportionate CVD mortality for the HIV-infected population increased significantly from 1999 to 2013 (p <0.0001); this pattern was consistent across races, particularly for men. In contrast, proportionate CVD mortality decreased for the general and inflammatory polyarthropathy populations from 1999 to 2013. In conclusion, CVD has become an increasingly common cause of death in HIV-infected subjects since 1999; understanding evolving mortality risks in the HIV-infected population is essential to inform routine clinical care of HIV-infected subjects as well as CVD prevention and treatment.

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Methods

We conducted the analysis using the publicly available detailed mortality database from the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER). The CDC WONDER database has been described previously and used for large epidemiologic studies published in recent years.17, 18, 19 The detailed mortality database within CDC WONDER consists of county-level national mortality and population data on the basis of death certificates of US

Results

Characteristics of the HIV-infected and general populations of persons aged 25 years and older at the time of death are provided in Table 1. Compared with the general population, HIV-infected subjects dying from CVD were more likely to be men, black, younger, urban-dwelling, and to have died in a medical facility. Among HIV-infected persons dying from any cause, those dying from CVD tended to be older.

For the overall HIV-infected population, CVD mortality increased from 1999 to 2013 but total

Discussion

In this study, we used a national US database of mortality data and found that the proportion of deaths related to CVD increased more than twofold in HIV-infected subjects between 1999 and 2013. This pattern was particularly apparent in men and contrasts sharply against the decrease in proportionate CVD-related mortality for the general US population and patients with inflammatory polyarthropathies during the same period. The increase in proportionate CVD mortality in HIV-infected persons is

Acknowledgment

The authors thank the Centers for Disease Control and Prevention (CDC) for the publicly available data from the CDC WONDER online database (http://wonder.cdc.gov/).

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