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Depression increases risk of heart attack for adults with HIV
Michael Carter, 2016-08-30 13:50:00
is associated with an increased risk of heart attack for middle-aged
HIV-positive patients, investigators from the United States report in JAMA Cardiology. Overall, presence of a
major depressive disorder (MDD) increased the risk of heart attack – acute
myocardial infarction (AMI) – by almost a third. Use of antidepressants
weakened the association between depression and heart attack risk, and there
was no evidence that milder forms of depression – dysthymic disorders – were
associated with an elevated risk of heart attack.
It’s already known
that depression is associated with an increased risk of cardiovascular disease
(CVD) in the general population. The present study is the first research to
show that major depression is also a heart attack risk factor for patients with
“We report novel
evidence suggesting that MDD is independently associated with AMI in the
HIV-infected population,” comment the authors. “We found that MDD at baseline
was associated with an increased risk for incident AMI over 5.8 years of
follow-up. Specifically, after adjustment for demographics, CVD risk factors
and HIV-specific factors, HIV-infected adults with MDD had a 30% greater risk
for having an AMI than did HIV-infected adults without MDD.”
believe their research had identified a new target for cardiovascular disease
prevention in HIV-positive patients that should be explored in further studies.
treatment and care mean that most patients with HIV now have an excellent life
expectancy. Diseases associated with older age are an increasingly important
cause of illness and death in HIV-positive patients, and prevention of
cardiovascular disease is a care priority.
Research in the
general population has shown that individuals with a depressive disorders are
up to 60% more likely to develop cardiovascular disease compared to individuals
with good mental health.
the Veterans Aging Cohort Study wanted to see if there was a similar
relationship between depression and heart attack risk in patients with HIV.
designed a prospective study involving 26,144 HIV-positive patients who entered
care between 1998 and 2003. Patients were followed between 2003 and 2009 to see
if the presence of a major or minor depressive disorder at baseline increased
the risk of heart attack during follow-up. The investigators adjusted their
findings in several models to take account of traditional cardiovascular risk factors,
HIV-related factors, co-infection with hepatitis C virus (HCV), drug use and
use of antidepressants.
The majority of
participants (>95%) were male and the average age at baseline was
approximately 47 years.
A major depressive disorder is defined by psychiatrists as a period of
at least two weeks of persistently low mood accompanied by symptoms such
as feelings of worthlessness, anxiety, pessimism, impaired
concentration, disturbed sleep, loss of interest in everyday activities,
reduced energy, and sometimes, thoughts of death or suicidal feelings. On entry to the
study, 19% of patients had a major depressive disorder with a further 9% having
a milder form of depression.
followed for a median of 5.8 years. During this time, there were 490 incident
heart attacks (2% of study population).
Patients with a
major depressive disorder at baseline had an increased risk of heart attack
compared to patients without major depression. The association was significant
in models that took into account demographics (HR = 1.31; 95% CI, 1.05-1.62),
cardiovascular risk factors (HR = 1.29; 95% CI, 1.04-1.60) and HIV-specific
factors (HR = 1.30; 95% CI, 1.05-1.62).
was weakened but still of borderline significance when the investigators took
into account other factors, such as HCV infection, substance abuse and
haemoglobin level (HR = 1.25; 95% CI, 1.00-1.56).
The authors also
adjusted their results to take account of baseline antidepressant therapy.
Overall, use of antidepressants meant that the association between major
depression and heart attack was no longer significant.
There was no
evidence that milder forms of depression increased the risk of heart attack.
suggest several reasons why major depression increased the risk of heart attack
for patients with HIV, including:
Changes in the autonomic
Poor health behaviours, such as
smoking, a sedentary lifestyle and sub-optimal adherence to treatment.
“We report novel
evidence that HIV-infected adults with MDD have a greater for AMI than
HIV-infected adults without MDD after adjustment for many potential
confounders,” conclude the investigators. “There is a need for clinical trials
designed to evaluate the effect of high-quality depression treatment on CVD
risk markers and incident events in HIV-infected adults with depression.”