HIV Infection and Incidence of Cardiovascular Diseases: An Analysis of a Large Healthcare Database
HIV Infection and Incidence of Cardiovascular Diseases: An Analysis of a Large Healthcare Database
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DOI：
10.1161/jaha.119.012241
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发表时间：
2019-07-16
影响因子：
5.4
通讯作者：
Marconi, Vincent
中科院分区：
文献类型：
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作者：
Alonso, Alvaro;Barnes, A. Elise;Marconi, Vincent
背景-与未感染者相比，艾滋病毒感染者（PLWH）患心肌梗塞（MI）和心力衰竭（HF）的风险更高。 PLWH 中其他心血管疾病 (CVD) 的风险较少受到关注。方法和结果 - 我们研究了 2009 年至 2015 年期间从 MarketScan 商业和医疗保险数据库中确定的 19 798 PLWH 和 59 302 名年龄和性别匹配的未感染者。使用经过验证的算法进行识别。我们使用调整后的 Cox 模型来估计 CVD 终点的风险比和 95% CI，并进行概率偏差分析以控制种族中无法测量的混杂因素。平均随访 20 个月后，患者出现 154 例心梗、223 例心力衰竭、93 例中风、397 例心房颤动、98 例外周动脉疾病和 935 例 CVD 住院（每 1000 人年的比率分别为：1.2、1.7、0.7、3.0、0.8 和 7.1）。感染者与未感染对照的危险比 (95% CI) 为：心肌梗死 1.3 (0.9-1.9)、心力衰竭 3.2 (2.4-4.2)、中风 2.7 (1.7-4.0)、心房颤动 1.2 (1.0-1.5)、外周动脉疾病 1.1 (0.7-1.7) 和 1.7 (1.5-2.0) 任何 CVD 住院治疗。对未测量的混杂因素进行调整后得出类似的关联（心肌梗死为 1.2 [0.8-1.8]，心力衰竭为 2.8 [2.0-3.8]，中风为 2.3 [1.5-3.6]，房颤为 1.3 [1.0-1.7]，外周动脉疾病为 0.9 [0.5-1.4]，外周动脉疾病为 1.6 [1.3-1.9]结论——在大型健康保险数据库中，PLWH 患 CVD 的风险较高，尤其是心力衰竭和中风。随着艾滋病毒人口的老龄化，制定心血管健康促进和心血管疾病预防的干预措施势在必行。
Background-People living with HIV (PLWH) experience higher risk of myocardial infarction (MI) and heart failure (HF) compared with uninfected individuals. Risk of other cardiovascular diseases (CVDs) in PLWH has received less attention.Methods and Results-We studied 19 798 PLWH and 59 302 age- and sex-matched uninfected individuals identified from the MarketScan Commercial and Medicare databases in the period 2009 to 2015. Incidence of CVDs, including MI, HF, atrial fibrillation, peripheral artery disease, stroke and any CVD-related hospitalization, were identified using validated algorithms. We used adjusted Cox models to estimate hazard ratios and 95% CIs of CVD end points and performed probabilistic bias analysis to control for unmeasured confounding by race. After a mean follow-up of 20 months, patients experienced 154 MIs, 223 HF, 93 stroke, 397 atrial fibrillation, 98 peripheral artery disease, and 935 CVD hospitalizations (rates per 1000 person-years: 1.2, 1.7, 0.7, 3.0, 0.8, and 7.1, respectively). Hazard ratios (95% CI) comparing PLWH with uninfected controls were 1.3 (0.9-1.9) for MI, 3.2 (2.4-4.2) for HF, 2.7 (1.7-4.0) for stroke, 1.2 (1.0-1.5) for atrial fibrillation, 1.1 (0.7-1.7) for peripheral artery disease, and 1.7 (1.5-2.0) for any CVD hospitalization. Adjustment for unmeasured confounding led to similar associations (1.2 [0.8-1.8] for MI, 2.8 [2.0-3.8] for HF, 2.3 [1.5-3.6] for stroke, 1.3 [1.0-1.7] for atrial fibrillation, 0.9 [0.5-1.4] for peripheral artery disease, and 1.6 [1.3-1.9] for CVD hospitalization).Conclusions-In a large health insurance database, PLWH have an elevated risk of CVD, particularly HF and stroke. With the aging of the HIV population, developing interventions for cardiovascular health promotion and CVD prevention is imperative.