HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome

Franck Boccara (1, 2) , Murielle Mary-Krause (3) , Valérie Potard (3) , Emmanuel Teiger (4, 5, 6) , Sylvie Lang (1) , Nadjib Hammoudi (7, 8) , Marion Chauvet (1) , Stéphane Ederhy (1) , Laurie Dufour-Soulat (1) , Yann Ancedy (1) , Pascal Nhan (1) , Saroumadi Adavane (1) , Ph Gabriel Steg (9) , Christian Funck-Brentano (7, 10, 11) , Dominique Costagliola (3) , Ariel Cohen (1)

1 CHU Saint-Antoine [AP-HP]
2 CRSA - Centre de Recherche Saint-Antoine
3 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
4 CHU Henri Mondor [Créteil]
5 IMRB - Institut Mondor de Recherche Biomédicale
6 CIC Henri Mondor - Centre d'Investigation Clinique Henri Mondor
7 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
8 Institut de cardiologie [CHU Pitié-Salpêtrière]
9 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
10 CIC Paris-Est - Centre d'investigation clinique Paris Est [CHU Pitié Salpêtrière]
11 CHU Pitié-Salpêtrière [AP-HP]

Background It is unclear whether HIV infection affects the long-term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV-uninfected (HIV-) patients, and to identify determinants of cardiovascular prognosis. Methods and Results Consecutive PLHIV and matched HIV- patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36-month follow-up. A total of 103 PLHIV and 195 HIV- patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow-up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- patients (17.8% and 15.1%, P=0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67-3.82 [P=0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32-30.21 [P=0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%; P=0.01) and had smaller total cholesterol decreases (-22.3 versus -35.0 mg/dL; P=0.04). Conclusions Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- individuals, PLHIV had a higher rate of recurrent ACS. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT00139958.

Mots clés: HIV; acute coronary syndrome; coronary artery disease; dyslipidemia; heart disease

Domaines: Sciences du Vivant [q-bio]

Franck Boccara, Murielle Mary-Krause, Valérie Potard, Emmanuel Teiger, Sylvie Lang, et al.. HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome. Journal of the American Heart Association, 2020, 9 (17), pp.e017578. ⟨10.1161/JAHA.119.017578⟩. ⟨hal-02945162⟩