Depressed HIV-infected Adults at Higher Risk for Heart Attack

Researchers at the Vanderbilt University School of Medicine have found that adults who are infected with the human immunodeficiency virus (HIV) and have major depressive disorder (MDD) are at a higher risk for cardiovascular disease (CVD) and are more likely to experience acute myocardial infarction (AMI), or a heart attack, than those who are not suffering from MDD, according to a press release. The study was published online by JAMA Cardiology.

According to the Centers for Disease Control and Prevention (CDC), there are more than 1.2 million HIV-infected individuals in the United States alone but with the aid of effective antiretroviral therapy (ART), these individuals are able to fight off the infection and live longer lives. However, researchers found that these individuals remain at a high risk for chronic comorbidities such as CVD. According to the study, CVD is actually the leading cause of death among these individuals.

As indicated in the study, previous research on the relationship between HIV and MDD over the past 30 years has found that “depression is independently associated with incident atherosclerotic CVD [and] meta-analyses have revealed that adults with depressive disorders, such as major depressive disorder (MDD) or dysthmic disorder, have a 40% to 60% increase risk for developing CVD than those without these conditions, even after adjustment for CVD risk factors.” In addition, a recent study found that HIV-infected hospitalized patients are actually at higher risk for suicide-related death.; With the link between MDD and HIV-infected patients already established, the researchers set out to discover how depression is associated with CVD in HIV-infected patients; as association which has not yet been examined, according to the press release.

The researchers analyzed the potential association of MDD as well as dysthmic disorder with AMI. The study authors noted, “In addition to MDD, dysthmic disorder warrants attention in this context as it is understudied and its milder but long-term course might have implications for CVD risk.”

The study, conducted by Matthew S. Freiberg, MD, MSc, of the Vanderbilt School of Medicine and team, consisted of 26,144 veterans infected with HIV. From April 2003 to December 2009, the infected veterans had participated in the US Department of Veterans Affairs Vetergans Aging Cohort Study; none of them had CVD prior to the study. Of the 26,144 veterans who participated in the study, about 19%, or 4,853 veterans, had MDD.

The average age of the veterans who had MDD was 47 years of age, compared with 48 years of age for those who did not have MDD. Over the duration of follow-up that lasted for almost six years (5.8), the researchers noted that 490 AMI events had occurred. In addition, the researchers found that after adjusting certain variables (CVD risk factors, demographics, and HIV-specific factors) 30% of the HIV-infected veterans who also had MDD were at higher risk for experiencing a heart attack than those who did not have MDD. After further adjusting variables (hepatitis C, kidney disease, substance abuse, and hemoglobin levels), the AMI risk reduced to 25%.

When speaking of the implications of these findings, the study authors wrote, “Our findings raise the possibility that, similar to the general population, MDD may be independently associated with incident atherosclerotic CVD in the HIV-infected population. Considering the dearth of research in this area, future epidemilogic and mechanistic studies that include women and non-VA populations with HIV are needed.”