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

2020; Wiley; Volume: 9; Issue: 17 Linguagem: Inglês

10.1161/jaha.119.017578

2047-9980

Franck Boccara, Murielle Mary‐Krause, Valérie Potard, Emmanuel Teíger, Sylvie Lang, Nadjib Hammoudi, Marion Chauvet, Stéphane Éderhy, Laurie Soulat-Dufour, Yann Ancédy, Pascal Nhan, Saroumadi Adavane, Philippe Gabríel Steg, Christian Funck‐Brentano, Dominique Costagliola, Ariel Cohen, Simon Weber, Karim Wahbi, Philippe Beaufils, Patrick Henri, Georges Sideris, Daniel Thomas, G. Montalescot, Farzin Beygui, Catherine Meuleman, Sandra Janower, François Raoux, Ghislaine Dufaître, Nadia Benyounes, Pablo Michel, B. Petillon, Nadjib Hammoudi, Pascal Guéret, Jean‐Luc Dubois‐Randé, Emmanuel Teíger, Pascal Lim, Michel Slama, Philippe Colin, C. Saudubray, O. Dubourg, Olivier Milleron, B Gallet, F. Duclos, Sophie Godard, Ludwig Fuchs, V Dormagen, Peter Lewy, Simon Cattan, O. Nallet, G Grollier, John Shayne, Jacek Wolf, Yves Cottin, J. Machecourt, H. Bouvaist, G Finet, Brigitte De Breyne, Jean‐Noël Trochu, Marcel Baudouy, Émile Ferrari, M Benhamou, J Allal, D. Coisne, Hervé Breton, Marc Bédossa, J. Puel, Meyer Elbaz, Laurent Larifla, Sophie Matheron, Roland Landman, Grégoire Martin de Frémont, Gabriela Spiridon, P. Blanche, J.-P. Morini, Didier Sicard, Valérie Zeller, D. Batisse, P. Clevenbergh, G. Cessot, Elisabeth Dohin, Marc‐Antoine Valantin, Sihem Khelifa, Pierre‐Marie Girard, F. Lallemand, Bénédicte Lefebvre, J.P. Laporte, J. L. Meynard, H. Bideault, O Picard, M. C. Meyohas, P. Campa, Jürgen Tredup, L. Fonquernie, G Raguin, Jean‐Michel Molina, André Furco, S. Gharakanian, Jean-Paul Vincensini, Jean–Baptiste Guiard–Schmid, Gilles Pialoux, Bernard Cardon, A.-S. Lascaux, F. Chaix, Philippe Lesprit, R Fior, François Boué, Christophe Dupont, C. Bellier, A. Blanc, Trevor W Lambert, Tahar Touahri, Gilles Force, P. de Truchis, M. A. Compagnucci‐Seguenot, I. Cahitte, Laurent Roudière, M. E. Techer, P. Thelpin, Didier Troisvallets, A. Leprêtre, Marie Echard, Yvon Le Mercier, D Houlbert, S. Dargère, Christophe Bazin, Renaud Verdon, B. De Goer, Michel Duong, P. Chavanet, E. Gozlan, P. Leclercq, F. Brunel‐Dal Mas, Joël M. Durant, P. Heudier, C. Brunet‐François, G. Le Moal, J. M. Chapplin, C. Arvieux, G. Chaumentin, Brigitte Guérin, Émilie Bonnet, Y. Poinsignon, F Boulard, I. De Lacroix, Marie-Thérèse Goerger-Sow, M. Kirstetter, M. Volstein, F. Laylavoix, X. Copin, C. Ceppi,

HIV Research and Treatment

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.