Depression and Human Immunodeficiency Virus Infection Are Risk Factors for Incident Heart Failure Among Veterans: Veterans Aging Cohort Study

BACKGROUND—Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF. METHODS AND RESULTS—Veterans A...

Full description

Saved in:
Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2015-10, Vol.132 (17), p.1630-1638
Main Authors: White, Jessica R, Chang, Chung-Chou H, So-Armah, Kaku A, Stewart, Jesse C, Gupta, Samir K, Butt, Adeel A, Gibert, Cynthia L, Rimland, David, Rodriguez-Barradas, Maria C, Leaf, David A, Bedimo, Roger J, Gottdiener, John S, Kop, Willem J, Gottlieb, Stephen S, Budoff, Matthew J, Khambaty, Tasneem, Tindle, Hilary A, Justice, Amy C, Freiberg, Matthew S
Format: Article
Language:English
Subjects:
Adult
Aging
Anti-HIV Agents - therapeutic use
Antidepressive Agents - therapeutic use
Cardiovascular Diseases - epidemiology
Comorbidity
Depressive Disorder, Major - drug therapy
Depressive Disorder, Major - epidemiology
Diabetes Mellitus - epidemiology
Electronic Health Records
Ethnic Groups - statistics & numerical data
Female
Follow-Up Studies
Heart Failure - epidemiology
HIV Infections - drug therapy
HIV Infections - epidemiology
Humans
Hyperlipidemias - epidemiology
Incidence
Kidney Diseases - epidemiology
Male
Middle Aged
Prospective Studies
Risk Factors
Substance-Related Disorders - epidemiology
United States - epidemiology
Veterans - statistics & numerical data
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:BACKGROUND—Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF. METHODS AND RESULTS—Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (n=81 42726 908 HIV+, 54 519 without HIV [HIV−]) were categorized into 4 groupsHIV− without major depressive disorder (MDD) [reference], HIV− with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% confidence interval [CI], 8.20–10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95% CI, 1.45–1.95) compared with HIV− participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV− and HIV+ participants (adjusted hazard ratio, 1.21; 95% CI, 1.06–1.37; and adjusted hazard ratio, 1.29; 95% CI, 1.11–1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95% CI, 0.58–0.99). CONCLUSIONS—Our study is the first to suggest that MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.114.014443