Depression and HIV Infection are Risk Factors for Incident Heart Failure among Veterans: Veterans Aging Cohort Study

Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among HIV+ adults. We assessed the association between HIV, depression and incident HF.

Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (N = 81,427; 26,908HIV+, 54,519 HIV-) were categorized into four groups: HIV- without major depressive disorder (MDD); HIV- with MDD; HIV+ without MDD; and HIV+ with MDD. ICD-9 codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 follow-up years, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% CI, 8.20-10.6). In Cox proportional hazards models, HIV+ participants with MDD had significantly higher risk of HF [adjusted hazard ratio (aHR) = 1.68; 95% CI, 1.45-1.95] compared to HIV- participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV- and HIV+ participants (aHR = 1.21; 1.06-1.37 and 1.29; 1.11-1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (aHR = 0.76; 0.58-0.99).

Our study is the first to suggest MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF; and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.

Via:  http://ht.ly/S9XeO 

By: White JR1, Chang CH2, So-Armah KA3, Stewart JC4, Gupta SK5, Butt AA6, Gibert CL7, Rimland D8, Rodriguez-Barradas MC9, Leaf DA10, Bedimo RJ11,Gottdiener JS12, Kop WJ13, Gottlieb SS14, Budoff MJ15, Khambaty T4, Tindle H16, Justice AC17, Freiberg MS18.

• 1University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
• 2University of Pittsburgh School of Medicine, Pittsburgh, PA.
• 3Boston University, Boston, MA.
• 4Indiana University-Purdue University Indianapolis, Indianapolis, IN.
• 5Indiana University School of Medicine, Indianapolis, IN.
• 6Hamad Medical Corporation, Doha, Qatar.
• 7VA Medical Center, Washington, DC.
• 8Emory University School of Medicine; Atlanta VA Medical Center, Decatur.
• 9Baylor College of Medicine, Houston, TX.
• 10UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, CA.
• 11VA North Texas Health Care System, Dallas, TX.
• 12University of Maryland Medical Center, Baltimore, MD.
• 13Tilburg University, Tilburg, the Netherlands.
• 14University of Maryland School of Medicine, Baltimore, MD.
• 15Los Angeles Biomedical Research Institute, Torrance, CA.
• 16Vanderbilt University School of Medicine, Nashville, TN.
• 17Yale University School of Medicine, New Haven, CT; Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, West Haven, CT.
• 18Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN