title: Myocardial infarction among Danish HIV-infected individuals: population-attributable fractions associated with smoking.
abstract: BACKGROUND
  Human immunodeficiency virus-infected individuals have increased risk of myocardial infarction (MI); however, the contribution from smoking and potentiating effects of HIV are controversial.
  
  
  METHODS
  From the Danish HIV Cohort Study and the Copenhagen General Population Study, we identified 3251 HIV-infected individuals and 13 004 population controls matched on age and gender. Data on MI were obtained from the National Hospital Registry and the National Registry of Causes of Death. We calculated adjusted incidence rate ratios (aIRR) for risk of MI and population-attributable fractions (PAF) of MI associated with smoking.
  
  
  RESULTS
  In never smokers, HIV was not associated with an increased risk of MI (aIRR, 1.01; 95% confidence interval [CI], .41-2.54). In previous and current smokers, HIV was associated with a substantially increased risk of MI (aIRR, 1.78; 95% CI, .75-4.24 and aIRR, 2.83; 95% CI, 1.71-4.70). The PAF associated with ever smoking (previous or current) was 72% (95% CI, 55%-82%) for HIV-infected individuals and 24% (95% CI, 3%-40%) for population controls. If all current smokers stopped smoking, 42% (95% CI, 21%-57%) and 21% (95% CI, 12%-28%) of all MIs could potentially be avoided in these 2 populations.
  
  
  CONCLUSIONS
  Smoking is associated with a higher risk of MI in the HIV-infected population than in the general population. Approximately 3 of 4 MIs among HIV-infected individuals are associated with ever smoking compared with only 1 of 4 MIs among population controls. Smoking cessation could potentially prevent more than 40% of MIs among HIV-infected individuals, and smoking cessation should be a primary focus in modern HIV care.
authors.affiliation: Department of Infectious Diseases, Odense University Hospital.
authors.forename: Line D
authors.initials: LD
authors.lastname: Rasmussen
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Helleberg
authors.affiliation: School of Social and Community Medicine, University of Bristol, United Kingdom.
authors.forename: Margaret T
authors.initials: MT
authors.lastname: May
authors.affiliation: The Copenhagen General Population Study Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev Hospital.
authors.forename: Shoaib
authors.initials: S
authors.lastname: Afzal
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital.
authors.forename: Gitte
authors.initials: G
authors.lastname: Kronborg
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Carsten S
authors.initials: CS
authors.lastname: Larsen
authors.affiliation: Department of Infectious Diseases, Odense University Hospital.
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Gerstoft
authors.affiliation: The Copenhagen General Population Study Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev Hospital.
authors.forename: Børge G
authors.initials: BG
authors.lastname: Nordestgaard
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D013997:Time Factors
keywords: HIV; cardiovascular disease; population attributable risk; smoking