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Clin Infect Dis. 2019 Aug 28. pii: ciz852. doi: 10.1093/cid/ciz852. [Epub ahead of print]

Sex- and Poverty-Specific Patterns in Hiv-Associated Cardiovascular Disease Mortality in New York City, 2007-2017.

Author information

1
Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY.
2
Bureau of HIV Prevention and Control, New York City Department of Health and Mental Hygiene, Long Island City, NY.
3
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
4
Cardiology Section, San Francisco Veterans Affairs Health Care System, University of California San Francisco, San Francisco, CA.
5
Departments of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
6
Division of Disease Control, New York City Department of Health and Mental Hygiene, Long Island City, NY.
7
Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.

Abstract

BACKGROUND:

HIV may affect the risk of death due to cardiovascular disease (CVD) differently in men versus women.

METHODS:

We examined CVD mortality rates between 2007 and 2017 among all HIV-positive New York City residents age 13+ by sex, using data from city HIV surveillance and vital statistics and the National Death Index. Residents without HIV were enumerated using modified US intercensal estimates. We determined associations of HIV status with CVD mortality by sex after accounting for age, race/ethnicity, year, and neighborhood poverty, defined as the percent living below the federal poverty level.

RESULTS:

There were 3,234 CVD deaths reported among 147,915 HIV-positive New Yorkers, with the proportion of deaths due to CVD increasing from 11% in 2007 to 22% in 2017. The age-standardized CVD mortality rate was 2.7/1,000 person-years among both men and women with HIV. The relative rate of CVD mortality associated with HIV status was significantly higher among women (adjusted rate ratio [aRR] 1.7, 95% CI 1.6-1.8) than men (aRR 1.2, 95% CI 1.1-1.3) overall, and within strata defined by neighborhood poverty. Sex differences in CVD mortality rates were the greatest comparing HIV-positive individuals having detectable HIV RNA and CD4+ T-cell counts <500 cells/uL with HIV-negative individuals.

CONCLUSIONS:

One in five deaths among people with HIV is now associated with CVD. HIV providers should recognize CVD risk among women with HIV, and reinforce preventive measures (e.g., smoking cessation, blood pressure control, lipid management) and viremic control among all people living with HIV to reduce CVD mortality.

KEYWORDS:

HIV infection; cardiovascular disease; mortality; poverty areas; sex; women

PMID:
31504325
DOI:
10.1093/cid/ciz852

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