Prevalence of cardiovascular diseases in HIV-infected outpatients: results from a prospective, multicenter cohort study

Abstract

Recent studies suggest a rising rate of cardiovascular disease (CVD) in HIV-infected subjects. Although most countries have an aging HIV-infected population, there remains a lack of knowledge about associated cardiovascular diseases. This ongoing prospective multicentre observational cohort study aims to elucidate CVD prevalence in HIV-infected outpatients by standardized non-invasive cardiovascular screening. Cardiovascular and coronary risk was calculated using Framingham risk scores. 803 HIV-infected subjects (mean age 44.2years, female 16.6%) were included. The prevalence of CVD in HIV-infected subjects was 10.1% (95% CI 8.0-12.2%). Aging HIV-infected patients (≥45years, N=348) exhibited significantly increased rates of CVD, including an elevated frequency of coronary artery disease (7.5 vs. 1.8%, p<0.001), myocardial infarction (6.0 vs. 1.8%, p=0.002) and peripheral arterial diseases (4.6 vs. 1.5%, p<0.017). Furthermore, aging patients exhibited a higher rate of chronic heart failure (5.2 vs. 1.5%, p<0.001), predominantly of ischemic etiology. In multivariate analyses, age (OR 2.05 per decade, 95% CI 1.64-2.56), smoking (OR 5.96 per decade, 95% CI 2.31-15.38) and advanced symptomatic HIV infection (OR 2.60 per decade, 95% CI 1.31-5.15), were significantly associated with the prevalence of CVD. Based on the 10-year cardiovascular risk estimation, a disproportionate increase in cardiac events has to be expected in aging HIV-infected subjects in the next decades (≥45years/<45years 16.4 vs. 4.2%, p<0.001). CVD in aging HIV-infected population is an increasing medical challenge. In the era of antiretroviral therapy, prevention and diagnostic strategies are essential to reduce the prevalence of CVD in HIV-infected patients.