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Depression, Anxiety in PWH Increases Myocardial Infarction Risk

Leigh Precopio
03/16/2023

People with HIV (PWH) who also have depression or anxiety may be at an increased risk for incident myocardial infarction (MI), according to the results of a recent study1 presented at the 2023 Conference on Retroviruses and Opportunistic Infections (CROI).

To better understand the relationship between mental health and types of acute MI in this patient population, the researchers examined data from 33,071 participants being observed for MI. Included participants were part of seven North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) clinical trials from 1997 to 2017. The NA-ACCORD is a research consortium of more than 20 cohorts across the United States and Canada and is considered one of the world's largest HIV studies.2

The primary outcome for the study included type 1 MI (T1MI), defined as plaque rupture or cardiac intervention, and type 2 MI (T2MI), defined as demand ischemia. Depression and anxiety were defined as a time-varying ICD-coded diagnosis prior to incident MI. All results were adjusted for traditional and HIV-related risk factors.

Of the total participants, 16,351 had a diagnosis of anxiety or depression of which 5432 were diagnosed with both. A total of 495 T1MIs and 374 T2MI occurred.

“Diagnosed depression was a significant predictor of T1MI and suggestive for T2MI among PWH, whereas anxiety was associated only with T2MI,” the researchers said of the study results.

Depression as a significant predictor of T1MI (adjusted hazard ratio [aHR] = 1.23; [95% CI, 1.02 - 1.49]) had a similar effect size, while anxiety as a significant predictor for T2MI (aHR = 1.42; [95% CI, 1.10 - 1.83]) had a strong effect size. Depression trended towards statistical significance for T2MI (aHR = 1.20; [95% CI, 0.96 - 1.51]) but anxiety was not found to be a significant predictor for T1MI (aHR = 0.92; [95% CI, 0.74 - 1.16]). The study results did not indicate an interaction between anxiety and depression.

Further, smoking was identified as a significant predictor for both T1MI and T2MI. Cocaine use and detectable viral load were identified as a significant predictor for T2MI.

“Further understanding of the role of mental health diagnosis and treatment to improve cardiovascular health among PWH is needed, including access to substance use disorder treatment and comorbidity management,” the researchers concluded.

 

Reference:

  1. Hyle EP, Humes E, Mukerji S, et al. Depression and anxiety associated with incident type 1 and type 2 MI among PWH. Talk presented at: Conference on Retroviruses and Opportunistic Infections (CROI); February 19-22, 2023; Seattle, WA. Accessed March 9, 2023. https://www.croiconference.org/abstract/depression-and-anxiety-associated-with-incident-type-i-and-ii-mi-among-pwh/.
  2. The North American AIDS Cohort Collaboration on Research and Design. About us. Accessed March 10, 2023. https://naaccord.org/about-us.