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Considerable number of deaths caused by sudden cardiac death in HIV

Issue: June 2012

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Second to mortality caused by AIDS in an urban HIV-infected population, sudden cardiac death was associated with 86% of cardiac deaths — 4.5-fold higher than researchers expected, according to findings published in the Journal of the American College of Cardiology.

During 3.7 years of median follow-up, there were 230 deaths, of which 30 met the criteria for sudden cardiac death; 131 were caused by AIDS; 25 were caused by other natural diseases; and 44 were caused by overdoses, suicides or unknown causes.

The mean rate of sudden cardiac death was 2.6 per 1,000 person-years (95% CI, 1.8-3.8), compared with 11.4 per 1,000 person-years (95% CI, 9.6-13.6) for AIDS deaths. By 2003, sudden cardiac death was the leading cause of non-AIDS natural deaths.

Patients who died of AIDS and patients who died of sudden cardiac death were similar in ethnicity and sex. Those who died of sudden cardiac death were 4.1 years older, had higher CD4 counts and lower viral loads. When compared with those who died of AIDS and other natural causes combined, those who died of sudden cardiac death had a higher prevalence of myocardial infarction, cardiomyopathy, heart failure, arrhythmias, hypertension and hyperlipidemia.

The study included data from the records of 2,860 consecutive patients in a public HIV clinic between April 2000 and August 2009. The researchers identified deaths, the cause of death and clinical characteristics using the National Death Index and/or clinical records.

“Given that cardiac symptoms were common in victims of sudden cardiac death, aggressive primary prevention of cardiovascular disease should be considered in HIV-infected patients, especially those with traditional risk factors,” the researchers wrote. “As we seek to reduce mortality in an aging HIV-infected population, greater attention must be directed to the mechanisms underlying sudden cardiac death.”

References:

• Tseng ZH. J Am Coll Cardiol. 2012;doi:10.1016/j.jacc.2012.02.024.

Disclosures:

• Dr. Tseng received honorarium from Biotronik.