Two decade trends in cardiovascular disease outcomes and cardiovascular risk factors among US veterans living with HIV

Mohammed Haji; Vrishali V Lopes; Augustus Ge; Christopher Halladay; Cullen Soares; Nishant R Shah; Christopher T Longenecker; Michelle Lally; Gerald S Bloomfield; Theresa I Shireman; David Ross; Jennifer L Sullivan; James L Rudolph; Wen-Chih Wu; Sebhat Erqou

doi:10.1016/j.ijcrp.2022.200151

Two decade trends in cardiovascular disease outcomes and cardiovascular risk factors among US veterans living with HIV

Int J Cardiol Cardiovasc Risk Prev. 2022 Sep 29:15:200151. doi: 10.1016/j.ijcrp.2022.200151. eCollection 2022 Dec.

Authors

Mohammed Haji¹, Vrishali V Lopes², Augustus Ge², Christopher Halladay², Cullen Soares³, Nishant R Shah^{1

4

5}, Christopher T Longenecker⁶, Michelle Lally^{1

4}, Gerald S Bloomfield⁷, Theresa I Shireman⁵, David Ross^{8

9}, Jennifer L Sullivan^{2

4

5}, James L Rudolph^{1

2

4

5}, Wen-Chih Wu^{1

2

4

5}, Sebhat Erqou^{1

2

4}

Affiliations

¹ Department of Medicine, Brown University, Providence, RI, USA.
² Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, RI, USA.
³ Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
⁴ Department of Medicine, Providence VA Medical Center, Providence, RI, USA.
⁵ Brown University School of Public Health, Brown University, Providence, RI, USA.
⁶ School of Medicine and Department of Global Health, University of Washington, Seattle, WA.
⁷ Duke Clinical Research Institute, Duke Global Health Institute and Department of Medicine, Duke University, Durham, NC, USA.
⁸ Office of Specialty Care Service, US Department of Veterans Affairs, USA.
⁹ Infectious Disease Section, Washington, DC Department of Veterans Affairs Medical Center, USA.

Abstract

Coomprhensive data on temporal trends in cardiovascular disease (CVD) risk factors and outcomes in people living with HIV are limited. Using retrospective data on 50,284 US Veterans living with HIV (VLWH) who received care in the VA from 2001 to 2019, we calculated the prevalence and incidence estimates of CVD risk factors and outcomes, as well as the average annual percent changes (AAPC) in the estimates. The mean age of the Veterans increased from 47.8 (9.1) years to 58.0 (12.4) years during the study period. The population remained predominantly (>95%) male and majority Black (∼50%). The prevalence of the CVD outcomes increased progressively over the study period: coronary artery disease (3.9%-18.7%), peripheral artery disease (2.3%, 10.3%), ischemic cerebrovascular disease (1.1%-9.9%), and heart failure (2.4%-10.5%). There was a progressive increase in risk factor burden, except for smoking which declined after 2015. The AAPC in prevalence was statistically significant for the CVD outcomes and risk factors. When adjusted for age, the predicted prevalence of CVD risk factors and outcomes showed comparable (but attenuated) trends. There was generally a comparable (but attenuated) trend in incidence of CVD outcomes, procedures, and risk factors over the study period. The use of statins increased from 10.6% (2001) to 40.8% (2019). Antiretroviral therapy usage increased from 77.7% (2001) to 85.0% (2019). In conclusion, in a retrospective analysis of large-scale VA data we found the burden and incidence of several CVD risk factors and outcomes have increased among VLWH over the past 20 years.

Keywords: CVD; CVD, Cardiovascular disesae; Cardiovascular disease; Disease burden; HIV; HIV, Human Immunodeficiency Virus; Human immunodeficiency virus; Risk factors; Trend.