title: HIV infection and the risk of acute myocardial infarction.
abstract: OBJECTIVE
  Whether people infected with human immunodeficiency virus (HIV) are at an increased risk of acute myocardial infarction (AMI) compared with uninfected people is not clear. Without demographically and behaviorally similar uninfected comparators and without uniformly measured clinical data on risk factors and fatal and nonfatal AMI events, any potential association between HIV status and AMI may be confounded.
  
  
  OBJECTIVE
  To investigate whether HIV is associated with an increased risk of AMI after adjustment for all standard Framingham risk factors among a large cohort of HIV-positive and demographically and behaviorally similar (ie, similar prevalence of smoking, alcohol, and cocaine use) uninfected veterans in care.
  
  
  METHODS
  Participants in the Veterans Aging Cohort Study Virtual Cohort from April 1, 2003, through December 31, 2009.
  
  
  METHODS
  After eliminating those with baseline cardiovascular disease, we analyzed data on HIV status, age, sex, race/ethnicity, hypertension, diabetes mellitus, dyslipidemia, smoking, hepatitis C infection, body mass index, renal disease, anemia, substance use, CD4 cell count, HIV-1 RNA, antiretroviral therapy, and incidence of AMI.
  
  
  METHODS
  Acute myocardial infarction.
  
  
  RESULTS
  We analyzed data on 82 459 participants. During a median follow-up of 5.9 years, there were 871 AMI events. Across 3 decades of age, the mean (95% CI) AMI events per 1000 person-years was consistently and significantly higher for HIV-positive compared with uninfected veterans: for those aged 40 to 49 years, 2.0 (1.6-2.4) vs 1.5 (1.3-1.7); for those aged 50 to 59 years, 3.9 (3.3-4.5) vs 2.2 (1.9-2.5); and for those aged 60 to 69 years, 5.0 (3.8-6.7) vs 3.3 (2.6-4.2) (P < .05 for all). After adjusting for Framingham risk factors, comorbidities, and substance use, HIV-positive veterans had an increased risk of incident AMI compared with uninfected veterans (hazard ratio, 1.48; 95% CI, 1.27-1.72). An excess risk remained among those achieving an HIV-1 RNA level less than 500 copies/mL compared with uninfected veterans in time-updated analyses (hazard ratio, 1.39; 95% CI, 1.17-1.66).
  
  
  CONCLUSIONS
  Infection with HIV is associated with a 50% increased risk of AMI beyond that explained by recognized risk factors.
authors: University of Pittsburgh School ofMedicine, Pittsburgh, PA 15213, USA. Freibergms@upmc.edu
authors: Matthew S
authors: MS
authors: Freiberg
authors: Chung-Chou H
authors: CC
authors: Chang
authors: Lewis H
authors: LH
authors: Kuller
authors: Melissa
authors: M
authors: Skanderson
authors: Elliott
authors: E
authors: Lowy
authors: Kevin L
authors: KL
authors: Kraemer
authors: Adeel A
authors: AA
authors: Butt
authors: Matthew
authors: M
authors: Bidwell Goetz
authors: David
authors: D
authors: Leaf
authors: Kris Ann
authors: KA
authors: Oursler
authors: David
authors: D
authors: Rimland
authors: Maria
authors: M
authors: Rodriguez Barradas
authors: Sheldon
authors: S
authors: Brown
authors: Cynthia
authors: C
authors: Gibert
authors: Kathy
authors: K
authors: McGinnis
authors: Kristina
authors: K
authors: Crothers
authors: Jason
authors: J
authors: Sico
authors: Heidi
authors: H
authors: Crane
authors: Alberta
authors: A
authors: Warner
authors: Stephen
authors: S
authors: Gottlieb
authors: John
authors: J
authors: Gottdiener
authors: Russell P
authors: RP
authors: Tracy
authors: Matthew
authors: M
authors: Budoff
authors: Courtney
authors: C
authors: Watson
authors: Kaku A
authors: KA
authors: Armah
authors: Donna
authors: D
authors: Doebler
authors: Kendall
authors: K
authors: Bryant
authors: Amy C
authors: AC
authors: Justice
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012306:Risk; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D014728:Veterans