title: HIV infection, cardiovascular disease risk factor profile, and risk for acute myocardial infarction.
abstract: BACKGROUND
  Traditional cardiovascular disease risk factors (CVDRFs) increase the risk of acute myocardial infarction (AMI) among HIV-infected (HIV+) participants. We assessed the association between HIV and incident AMI within CVDRF strata.
  
  
  METHODS
  Cohort-81,322 participants (33% HIV+) without prevalent CVD from the Veterans Aging Cohort Study Virtual Cohort (prospective study of HIV+ and matched HIV- veterans) participated in this study. Veterans were followed from first clinical encounter on/after April 1, 2003, until AMI/death/last follow-up date (December 31, 2009). Predictors-HIV, CVDRFs (total cholesterol, cholesterol-lowering agents, blood pressure, blood pressure medication, smoking, diabetes) used to create 6 mutually exclusive profiles: all CVDRFs optimal, 1+ nonoptimal CVDRFs, 1+ elevated CVDRFs, and 1, 2, 3+ major CVDRFs. Outcome-Incident AMI [defined using enzyme, electrocardiogram (EKG) clinical data, 410 inpatient ICD-9 (Medicare), and/or death certificates]. Statistics-Cox models adjusted for demographics, comorbidity, and substance use.
  
  
  RESULTS
  Of note, 858 AMIs (42% HIV+) occurred over 5.9 years (median). Prevalence of optimal cardiac health was <2%. Optimal CVDRF profile was associated with the lowest adjusted AMI rates. Compared with HIV- veterans, AMI rates among HIV+ veterans with similar CVDRF profiles were higher. Compared with HIV- veterans without major CVDRFs, HIV+ veterans without major CVDRFs had a 2-fold increased risk of AMI (HR: 2.0; 95% confidence interval: 1.0 to 3.9; P = 0.044).
  
  
  CONCLUSIONS
  The prevalence of optimal cardiac health is low in this cohort. Among those without major CVDRFs, HIV+ veterans have twice the AMI risk. Compared with HIV- veterans with high CVDRF burden, AMI rates were still higher in HIV+ veterans. Preventing/reducing CVDRF burden may reduce excess AMI risk among HIV+ people.
authors.affiliation: *Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Departments of †Biostatistics; ‡Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; §Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; ‖Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA David Geffen School of Medicine at UCLA, Los Angeles, CA; ¶Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Los Angeles, CA; #VA Medical Center; Department of Medicine, Emory University School of Medicine, Atlanta, GA; **Infectious Disease Section, Department of Medicine, VA North Texas Health Care System, UT Southwestern Medical Center, Dallas, TX; ††Infectious Diseases Section, Michael E. DeBakey VA Medical Center; Baylor College of Medicine, Houston, TX; ‡‡Department of Medicine, University of Washington, Seattle, WA; §§VA Medical Center and George Washington University Medical Center, Washington, DC; ‖‖Department of Internal Medicine, The Mount Sinai Medical Center; Bronx Veterans Affairs Medical Center, NY; ¶¶Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA. ##Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; ***VA Connecticut Healthcare System, West Haven, CT; †††VA Connecticut Healthcare System, West Haven, CT, and Section of General Medicine, Yale University School of Medicine, New Haven, CT; and ‡‡‡Vanderbilt University School of Medicine and Nashville Veterans Affairs Medical Center, Nashville TN.
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Paisible
authors.forename: Chung-Chou H
authors.initials: CC
authors.lastname: Chang
authors.forename: Kaku A
authors.initials: KA
authors.lastname: So-Armah
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.forename: David A
authors.initials: DA
authors.lastname: Leaf
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Roger
authors.initials: R
authors.lastname: Bedimo
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Goetz
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gibert
authors.forename: Sheldon T
authors.initials: ST
authors.lastname: Brown
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Tindle
authors.forename: Alberta L
authors.initials: AL
authors.lastname: Warner
authors.forename: Charles
authors.initials: C
authors.lastname: Alcorn
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Freiberg
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014728:Veterans