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Depression may increase HF risk among HIV-positive veterans
Major depressive disorder has been identified as a possible independent risk factor for HF among older veterans with HIV.
Risk for CVD is higher for adults with HIV, who have nearly double the risk for depression compared with adults of the same age, sex and race/ethnicity without HIV, according to background information in the study.
“It stands to reason that HIV-positive adults with [major depressive disorder] may be at a heightened risk for HF compared to the remaining population; however, to date, no studies have examined the risk of HF in individuals burdened with co-occurring HIV and [major depressive disorder],” Jessica White, MS, from the department of epidemiology at University of Pittsburgh Graduate School of Public Health, and colleagues wrote.
Researchers studied 81,427 participants (26,908 HIV-positive; 54,519 HIV-negative) from the Veterans Aging Cohort Study (mean age, 48 years). All participants were free of CVD at baseline (April 1, 2003) and were followed until an HF event, death or the follow-up end date, Dec. 31, 2009.
Participants were categorized into four groups: HIV-negative without major depressive disorder (56.2%); HIV-negative with major depressive disorder (10.8%); HIV-positive without major depressive disorder (26.8%); and HIV-positive with major depressive disorder (6.2%).
Overall, the prevalence of major depressive disorder in the Veterans Aging Cohort Study was 17%. Prevalence was similar between patients with and without HIV (18.8% vs. 16.1%).
During a median follow-up of 5.8 years, 2,666 incident HF events occurred. The rate of HF events was highest among participants with HIV and major depressive disorder (9.32 events per 1,000 person-years).
Major depressive disorder was associated with increased risk for HF in participants with or without HIV (HIV-negative: adjusted HR = 1.21; 95% CI, 1.06-1.37; HIV-positive: adjusted HR = 1.29; 95% CI, 1.11-1.51), according to fully adjusted models.
Participants with HIV and major depressive disorder had a significantly increased risk for HF compared with patients without HIV or major depressive disorder (adjusted HR = 1.68; 95% CI, 1.45-1.95), according to Cox proportional hazards models.
Use of antidepressants at baseline was associated with reduced risk for incident HF events (adjusted HR = 0.76; 95% CI, 0.58-0.99). More than 90% of participants with major depressive disorder reported use of at least one antidepressant medication at baseline.
According to the researchers, these results reinforce the importance of screening for and effectively managing depression in this patient population.
“Future studies must clarify mechanisms linking HIV, [major depressive disorder], antidepressants and HF; and identify interventions to reduce HF morbidity and mortality in those with both HIV and [major depressive disorder],” White and colleagues wrote. – by Trish Shea, MA
Disclosure: The researchers report no relevant financial disclosures.