Association Between Depressive Disorders and Incident Acute Myocardial Infarction in Human Immunodeficiency Virus-Infected Adults

Veterans Aging Cohort Study

Tasneem Khambaty, Jesse C. Stewart, Samir Gupta, Chung Chou H. Chang, Roger J. Bedimo, Matthew J. Budoff, Adeel A. Butt, Heidi Crane, Cynthia L. Gibert, David A. Leaf, David Rimland, Hilary A. Tindle, Kaku A. So-Armah, Amy C. Justice, Matthew S. Freiberg

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Importance: With the advent of highly effective antiretroviral therapy and improved survival, human immunodeficiency virus (HIV)-infected people are living longer and are now at an increased risk for cardiovascular disease (CVD). There is an urgent need to identify novel risk factors and primary prevention approaches for CVD in HIV. Although depression is prevalent in HIV-infected adults and is associated with future CVD in the general population, its association with CVD events has not been examined in the HIV-infected population.

Objective: To examine whether depressive disorders are prospectively associated with incident acute myocardial infarction (AMI) in a large cohort of adults with HIV.

Design, Setting, and Participants: Included in this cohort study were 26 144 HIV-infected veterans without CVD at baseline (1998-2003) participating in the US Department of Veterans Affairs Veterans Aging Cohort Study from April 1, 2003, through December 31, 2009. At baseline, 4853 veterans (19%) with major depressive disorder (MDD; International Classification of Diseases, Ninth Revision [ICD-9] codes 296.2 and 296.3) and 2296 (9%) with dysthymic disorder (ICD-9 code 300.4) were identified. The current analysis was conducted from January 2015 to November 2015.

Main Outcomes and Measures: Incident AMI (defined by discharge summary documentation, enzyme/electrocardiography evidence of AMI, inpatient ICD-9 code for AMI (410), or AMI as underlying cause of death [International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code 121]) between the enrollment date and December 31, 2009.

Results: The mean (SD) age of those with MDD was 47.3 (7.9) years and for those without MDD was 48.2 (9.7) years. During 5.8 years of follow-up, 490 AMI events (1.9%) occurred. Baseline MDD was associated with incident AMI after adjusting for demographics (hazard ratio [HR], 1.31; 95% CI, 1.05-1.62), CVD risk factors (HR, 1.29; 95% CI, 1.04-1.60), and HIV-specific factors (HR, 1.30; 95% CI, 1.05-1.62). Further adjustment for hepatitis C, renal disease, substance abuse, and hemoglobin level (HR, 1.25; 95% CI, 1.00-1.56) and antidepressant use (HR, 1.12; 95% CI, 0.87-1.42) attenuated associations. Baseline dysthymic disorder was not associated with incident AMI.

Conclusions and Relevance: We report novel evidence that HIV-infected adults with MDD have a 30% increased risk for AMI than HIV-infected adults without MDD after adjustment for many potential confounders. Our findings raise the possibility that MDD may be independently associated with incident atherosclerotic CVD in the HIV-infected population.

Original languageEnglish (US)
Pages (from-to)929-937
Number of pages9
JournalJAMA Cardiology
Volume1
Issue number8
DOIs
StatePublished - Nov 1 2016

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Veterans
Depressive Disorder
International Classification of Diseases
Cohort Studies
Myocardial Infarction
HIV
Cardiovascular Diseases
Dysthymic Disorder
Population
United States Department of Veterans Affairs
Major Depressive Disorder
Primary Prevention
Hepatitis C
Documentation
Antidepressive Agents
Substance-Related Disorders
Inpatients
Cause of Death
Electrocardiography
Hemoglobins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association Between Depressive Disorders and Incident Acute Myocardial Infarction in Human Immunodeficiency Virus-Infected Adults : Veterans Aging Cohort Study. / Khambaty, Tasneem; Stewart, Jesse C.; Gupta, Samir; Chang, Chung Chou H.; Bedimo, Roger J.; Budoff, Matthew J.; Butt, Adeel A.; Crane, Heidi; Gibert, Cynthia L.; Leaf, David A.; Rimland, David; Tindle, Hilary A.; So-Armah, Kaku A.; Justice, Amy C.; Freiberg, Matthew S.

In: JAMA Cardiology, Vol. 1, No. 8, 01.11.2016, p. 929-937.

Research output: Contribution to journalArticle

Khambaty, T, Stewart, JC, Gupta, S, Chang, CCH, Bedimo, RJ, Budoff, MJ, Butt, AA, Crane, H, Gibert, CL, Leaf, DA, Rimland, D, Tindle, HA, So-Armah, KA, Justice, AC & Freiberg, MS 2016, 'Association Between Depressive Disorders and Incident Acute Myocardial Infarction in Human Immunodeficiency Virus-Infected Adults: Veterans Aging Cohort Study', JAMA Cardiology, vol. 1, no. 8, pp. 929-937. https://doi.org/10.1001/jamacardio.2016.2716
Khambaty, Tasneem ; Stewart, Jesse C. ; Gupta, Samir ; Chang, Chung Chou H. ; Bedimo, Roger J. ; Budoff, Matthew J. ; Butt, Adeel A. ; Crane, Heidi ; Gibert, Cynthia L. ; Leaf, David A. ; Rimland, David ; Tindle, Hilary A. ; So-Armah, Kaku A. ; Justice, Amy C. ; Freiberg, Matthew S. / Association Between Depressive Disorders and Incident Acute Myocardial Infarction in Human Immunodeficiency Virus-Infected Adults : Veterans Aging Cohort Study. In: JAMA Cardiology. 2016 ; Vol. 1, No. 8. pp. 929-937.
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abstract = "Importance: With the advent of highly effective antiretroviral therapy and improved survival, human immunodeficiency virus (HIV)-infected people are living longer and are now at an increased risk for cardiovascular disease (CVD). There is an urgent need to identify novel risk factors and primary prevention approaches for CVD in HIV. Although depression is prevalent in HIV-infected adults and is associated with future CVD in the general population, its association with CVD events has not been examined in the HIV-infected population.Objective: To examine whether depressive disorders are prospectively associated with incident acute myocardial infarction (AMI) in a large cohort of adults with HIV.Design, Setting, and Participants: Included in this cohort study were 26 144 HIV-infected veterans without CVD at baseline (1998-2003) participating in the US Department of Veterans Affairs Veterans Aging Cohort Study from April 1, 2003, through December 31, 2009. At baseline, 4853 veterans (19{\%}) with major depressive disorder (MDD; International Classification of Diseases, Ninth Revision [ICD-9] codes 296.2 and 296.3) and 2296 (9{\%}) with dysthymic disorder (ICD-9 code 300.4) were identified. The current analysis was conducted from January 2015 to November 2015.Main Outcomes and Measures: Incident AMI (defined by discharge summary documentation, enzyme/electrocardiography evidence of AMI, inpatient ICD-9 code for AMI (410), or AMI as underlying cause of death [International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code 121]) between the enrollment date and December 31, 2009.Results: The mean (SD) age of those with MDD was 47.3 (7.9) years and for those without MDD was 48.2 (9.7) years. During 5.8 years of follow-up, 490 AMI events (1.9{\%}) occurred. Baseline MDD was associated with incident AMI after adjusting for demographics (hazard ratio [HR], 1.31; 95{\%} CI, 1.05-1.62), CVD risk factors (HR, 1.29; 95{\%} CI, 1.04-1.60), and HIV-specific factors (HR, 1.30; 95{\%} CI, 1.05-1.62). Further adjustment for hepatitis C, renal disease, substance abuse, and hemoglobin level (HR, 1.25; 95{\%} CI, 1.00-1.56) and antidepressant use (HR, 1.12; 95{\%} CI, 0.87-1.42) attenuated associations. Baseline dysthymic disorder was not associated with incident AMI.Conclusions and Relevance: We report novel evidence that HIV-infected adults with MDD have a 30{\%} increased risk for AMI than HIV-infected adults without MDD after adjustment for many potential confounders. Our findings raise the possibility that MDD may be independently associated with incident atherosclerotic CVD in the HIV-infected population.",
author = "Tasneem Khambaty and Stewart, {Jesse C.} and Samir Gupta and Chang, {Chung Chou H.} and Bedimo, {Roger J.} and Budoff, {Matthew J.} and Butt, {Adeel A.} and Heidi Crane and Gibert, {Cynthia L.} and Leaf, {David A.} and David Rimland and Tindle, {Hilary A.} and So-Armah, {Kaku A.} and Justice, {Amy C.} and Freiberg, {Matthew S.}",
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T1 - Association Between Depressive Disorders and Incident Acute Myocardial Infarction in Human Immunodeficiency Virus-Infected Adults

T2 - Veterans Aging Cohort Study

AU - Khambaty, Tasneem

AU - Stewart, Jesse C.

AU - Gupta, Samir

AU - Chang, Chung Chou H.

AU - Bedimo, Roger J.

AU - Budoff, Matthew J.

AU - Butt, Adeel A.

AU - Crane, Heidi

AU - Gibert, Cynthia L.

AU - Leaf, David A.

AU - Rimland, David

AU - Tindle, Hilary A.

AU - So-Armah, Kaku A.

AU - Justice, Amy C.

AU - Freiberg, Matthew S.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Importance: With the advent of highly effective antiretroviral therapy and improved survival, human immunodeficiency virus (HIV)-infected people are living longer and are now at an increased risk for cardiovascular disease (CVD). There is an urgent need to identify novel risk factors and primary prevention approaches for CVD in HIV. Although depression is prevalent in HIV-infected adults and is associated with future CVD in the general population, its association with CVD events has not been examined in the HIV-infected population.Objective: To examine whether depressive disorders are prospectively associated with incident acute myocardial infarction (AMI) in a large cohort of adults with HIV.Design, Setting, and Participants: Included in this cohort study were 26 144 HIV-infected veterans without CVD at baseline (1998-2003) participating in the US Department of Veterans Affairs Veterans Aging Cohort Study from April 1, 2003, through December 31, 2009. At baseline, 4853 veterans (19%) with major depressive disorder (MDD; International Classification of Diseases, Ninth Revision [ICD-9] codes 296.2 and 296.3) and 2296 (9%) with dysthymic disorder (ICD-9 code 300.4) were identified. The current analysis was conducted from January 2015 to November 2015.Main Outcomes and Measures: Incident AMI (defined by discharge summary documentation, enzyme/electrocardiography evidence of AMI, inpatient ICD-9 code for AMI (410), or AMI as underlying cause of death [International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code 121]) between the enrollment date and December 31, 2009.Results: The mean (SD) age of those with MDD was 47.3 (7.9) years and for those without MDD was 48.2 (9.7) years. During 5.8 years of follow-up, 490 AMI events (1.9%) occurred. Baseline MDD was associated with incident AMI after adjusting for demographics (hazard ratio [HR], 1.31; 95% CI, 1.05-1.62), CVD risk factors (HR, 1.29; 95% CI, 1.04-1.60), and HIV-specific factors (HR, 1.30; 95% CI, 1.05-1.62). Further adjustment for hepatitis C, renal disease, substance abuse, and hemoglobin level (HR, 1.25; 95% CI, 1.00-1.56) and antidepressant use (HR, 1.12; 95% CI, 0.87-1.42) attenuated associations. Baseline dysthymic disorder was not associated with incident AMI.Conclusions and Relevance: We report novel evidence that HIV-infected adults with MDD have a 30% increased risk for AMI than HIV-infected adults without MDD after adjustment for many potential confounders. Our findings raise the possibility that MDD may be independently associated with incident atherosclerotic CVD in the HIV-infected population.

AB - Importance: With the advent of highly effective antiretroviral therapy and improved survival, human immunodeficiency virus (HIV)-infected people are living longer and are now at an increased risk for cardiovascular disease (CVD). There is an urgent need to identify novel risk factors and primary prevention approaches for CVD in HIV. Although depression is prevalent in HIV-infected adults and is associated with future CVD in the general population, its association with CVD events has not been examined in the HIV-infected population.Objective: To examine whether depressive disorders are prospectively associated with incident acute myocardial infarction (AMI) in a large cohort of adults with HIV.Design, Setting, and Participants: Included in this cohort study were 26 144 HIV-infected veterans without CVD at baseline (1998-2003) participating in the US Department of Veterans Affairs Veterans Aging Cohort Study from April 1, 2003, through December 31, 2009. At baseline, 4853 veterans (19%) with major depressive disorder (MDD; International Classification of Diseases, Ninth Revision [ICD-9] codes 296.2 and 296.3) and 2296 (9%) with dysthymic disorder (ICD-9 code 300.4) were identified. The current analysis was conducted from January 2015 to November 2015.Main Outcomes and Measures: Incident AMI (defined by discharge summary documentation, enzyme/electrocardiography evidence of AMI, inpatient ICD-9 code for AMI (410), or AMI as underlying cause of death [International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code 121]) between the enrollment date and December 31, 2009.Results: The mean (SD) age of those with MDD was 47.3 (7.9) years and for those without MDD was 48.2 (9.7) years. During 5.8 years of follow-up, 490 AMI events (1.9%) occurred. Baseline MDD was associated with incident AMI after adjusting for demographics (hazard ratio [HR], 1.31; 95% CI, 1.05-1.62), CVD risk factors (HR, 1.29; 95% CI, 1.04-1.60), and HIV-specific factors (HR, 1.30; 95% CI, 1.05-1.62). Further adjustment for hepatitis C, renal disease, substance abuse, and hemoglobin level (HR, 1.25; 95% CI, 1.00-1.56) and antidepressant use (HR, 1.12; 95% CI, 0.87-1.42) attenuated associations. Baseline dysthymic disorder was not associated with incident AMI.Conclusions and Relevance: We report novel evidence that HIV-infected adults with MDD have a 30% increased risk for AMI than HIV-infected adults without MDD after adjustment for many potential confounders. Our findings raise the possibility that MDD may be independently associated with incident atherosclerotic CVD in the HIV-infected population.

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