FROM JAMA Cardiology

Major depressive disorder is associated with a significant increase in the risk of acute myocardial infarction in adults infected with HIV, even after accounting for existing cardiovascular and HIV-related risk factors, according to research published online Aug. 24 in JAMA Cardiology.

Researchers conducted a retrospective analysis of data from 26,144 HIV-infected veterans participating in the U.S. Department of Veterans Affairs Veterans Aging Cohort Study. Among these veterans, 4,853 (19%) had major depressive disorder and 2,296 (9%) had dysthymic disorder.

After adjustment for cardiovascular risk factors such as hypertension and lipid levels, HIV-infected individuals with major depressive disorder had a 29% higher risk of acute MI compared with HIV-infected individuals without major depressive disorder.

This association remained at the same level but lost its statistical significance after adjustment for hepatitis C infection, renal disease, and alcohol or cocaine dependence ( JAMA Cardiology 2016, Aug 24. doi: 10.1001/jamacardio.2016.2716 ).

Acute myocardial event risk was not significantly increased in HIV-infected individuals with dysthymic disorder, although the hazard ratios themselves were only slightly smaller than those of people with major depressive disorder.

Depression is a known independent risk factor for cardiovascular disease; the authors cited one meta-analysis of 16 studies in the general population that suggested a 57% increase in cardiovascular risk associated with depression.

“Similar to the general population, MDD may be independently associated with incident atherosclerotic CVD in the HIV infected population,” wrote Tasneem Khambaty, PhD, of the University of Miami, and coauthors.

“Given the greater risk for CVD of HIV-infected adults and adults with depression separately and the high prevalence (24%-40%) of depressive disorders in those with HIV, a key remaining question is the following: Is depression independently associated with incident atherosclerotic CVD in the HIV infected population?” the authors asked.

The same mechanisms that increase the risk of cardiovascular disease with depression in the general population also appear to be at play in individuals with HIV, the authors said.

Certain HIV medications such as efavirenz have been independently associated with depression, suicidality, and an increased risk of acute MI events, although researchers said this would not have accounted for the increase in risk observed in this study.

The Veterans Aging Cohort Study was funded by the National Institute on Alcohol Abuse and Alcoholism, and Veterans Health Administration Public Health Strategic Health Core Group, and this analysis was partly supported by funding from the National Institutes of Health. Two authors declared grants and other funding from pharmaceutical companies, two declared grants from the National Institutes of Health, and one author disclosed a grant from General Electric. No other conflicts of interest were disclosed.


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