Abstract 16770: HIV Infection is Associated With Higher Risk of Sudden Cardiac Death: Results From the Veterans Aging Cohort Study Virtual Cohort
Background: HIV-infected individuals have higher rates of cardiovascular disease (CVD) compared to uninfected individuals, and our group has shown that rates of sudden cardiac death (SCD) are substantially higher among HIV-infected individuals compared to the general population in San Francisco. However, the direct effect of HIV infection on the rate and risk of SCD in demographically and behaviorally similar HIV+ and HIV- members of a large multicenter cohort is unknown.
Methods: We evaluated the association between HIV infection and SCD using the Veterans Aging Cohort Study Virtual Cohort, a prospective, longitudinal cohort of HIV+ and 1:2 age, race/ethnicity, and clinical site matched HIV- Veterans enrolled in the same calendar year. After eliminating those with baseline CVD, we analyzed data on HIV status, age, sex, race/ethnicity, hypertension, diabetes mellitus, dyslipidemia, smoking, hepatitis C, body mass index, renal disease, anemia, substance use, and SCD incidence. SCD was defined as an out-of-hospital death from a cardiac cause based on ICD-10 diagnoses obtained from death certificates. Rates and risks of SCD were calculated per 10,000 person years (PY) and assessed using Cox proportional hazards models, respectively.
Results: We analyzed data on 80,746 participants (33% HIV+). During a median follow-up of 5.9 years, 1274 SCD events occurred (44% HIV+). SCD rates per 10,000 PY were 43.2 (95% CI 39.8-47.0) and 26.5 (95% CI 24.6-28.5) for HIV+ and HIV- groups, respectively. Adjusting for age, gender, Framingham risk factors, comorbidities, and substance use, HIV+ Veterans had an increased risk of incident SCD compared with HIV- Veterans (HR 1.45, 95% CI 1.29-1.64). Other significant risk factors were older age, white race, hypertension, diabetes, smoking, renal insufficiency, alcohol abuse and dependence, and anemia (p<0.05 for all). The median Framingham risk score at baseline was the same (FRS=6) for both HIV+ and HIV- Veterans.
Conclusions: HIV+ Veterans have a 60% higher rate and 45% greater relative hazard of SCD than HIV- Veterans even after adjustment for age, gender, Framingham risk factors, comorbidities, and substance use. In a large multicenter cohort, HIV-infection is independently associated with a higher risk of SCD.
- © 2013 by American Heart Association, Inc.