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Type 2 MI in patients with HIV often caused by unconventional factors
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More than half of individuals with HIV who had an MI had a type 2 MI, and risk factors for and causes of MI differed by MI type, according to new data.
“[HIV] may affect lipid levels and endothelial function, leading to increased risk of CVD,” Heidi M. Crane, MD, MPH, associate professor of allergy and infectious diseases at the University of Washington, and colleagues wrote. “Previous studies have used unadjudicated MI outcomes and have not differentiated the types of MI.”
Crane and colleagues used the Center for AIDS Research Network of Integrated Clinical Systems cohort to analyze data from individuals with HIV who had an MI from 1996 to March 2014 at six sites.
Two physician experts categorized the MIs as type 1, which result from instability of atherosclerotic plaque, or type 2, which result from a mismatch between oxygen supply and demand.
In the cohort of patients with definite or probable MIs (n = 571; 430 men; median age, 49 years), 50.4% were type 2 MIs (n = 288) and 49.6% were type 1 (n = 283). An additional 79 patients, who did not have an MI but had atherosclerotic disease severe enough to require coronary intervention, were added to the cohort.
Researchers found that the most common causes of type 2 MIs were sepsis or bacteremia (34.7%) and recent use of cocaine or other illicit drugs (13.5%).
When compared with those with type 1 MIs or those who underwent cardiac interventions, more patients with type 2 MIs were younger than 40 years (type 2, 16.3%; others, 8.8%; P = .01) and had lower current CD4 cell counts (type 2: median, 230 cells/µL; others: median, 383 cells/µL; P = .02), lipid levels (type 2: mean total cholesterol level, 167 mg/dL; others: mean total cholesterol level, 190 mg/dL; P < .001) and mean Framingham 10-year CHD risk scores (type 2, 8%; others, 10%; P < .001).
Additionally, compared with the others, a higher portion of patients with type 2 MI were black (70.1% vs. 43.1%; P < .001), women (28.1% vs. 19.1%; P = .006) and not receiving antiretroviral therapy (46.5% vs. 25.1%; P < .001), Crane and colleagues found.
“These findings have important implications for studying MIs, understanding the higher MI rates, and determining whether the extent burden of MI can be reduced by modifications of CVD risk factors among HIV-infected individuals, particularly given the unknown role, if any, of atherosclerosis in [type 2] MIs,” the researchers wrote. “Understanding types of MI may help clarify unanswered questions regarding risk factors, risk scoring and prognosis. Most important, these finding are important clinically, as [type 1] MI and [type 2] MI may require different approaches for prevention and treatment in HIV-infected individuals.” – by Cassie Homer
Disclosures: Crane reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.
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