Depression and Human Immunodeficiency Virus Infection Are Risk Factors for Incident Heart Failure Among Veterans Veterans Aging Cohort Study

• Type of Material: Article
• Authors: Jessica R. White, University of Pittsburgh; Chung-Chou H. Chang, University of Pittsburgh; Kaku A. So-Armah, Boston University; Jesse C. Stewart, Indiana University-Purdue University Indianapolis; Samir Kumar Gupta, Indiana University; Adeel A. Butt, Hamad Medical Corporation; Cynthia L. Gibert, VA Medical Center; David Rimland, Emory University; Maria C. Rodriguez-Barradas, Baylor College of Medicine; David A. Leaf, University of California Los Angeles; Roger J. Bedimo, VA North Texas Health Care System; John S. Gottdiener, University of Maryland; Willem J. Kop, Tilburg University; Stephen S. Gottlieb, University of Maryland; Matthew J. Budoff, Los Angeles Biomedical Research Institute; Tasneem Khambaty, Indiana University-Purdue University Indianapolis; Hilary Tindle, Vanderbilt University; Amy C. Justice, Yale University; Matthew S. Freiberg, Vanderbilt University
• Language: English
• Date: 2015-10-27
• Publisher: American Heart Association
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/CIRCULATIONAHA.114.014443
• Title of Journal or Parent Work: Circulation
• ISSN: 0009-7322
• Volume: 132
• Issue: 17
• Start Page: 1630
• End Page: 1638
• Grant/Funding Information: This work was supported by grants HL095136, and T32 Cardiovascular Epidemiology Training Program HL083825, from the National Heart, Lung, and Blood Institute and grants AA013566, AA020790, and AA020794 from the National Institutes of Health on Alcohol Abuse and Alcoholism at the NIH.
• Keywords: HEALTH; heart failure; ATHEROSCLEROSIS; Cardiovascular System & Cardiology; ASSOCIATION; HIV; HIV-INFECTION; Science & Technology; SYSTEM; depression; CARDIOVASCULAR EVENTS; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; epidemiology; Peripheral Vascular Disease; COMORBIDITIES; MECHANISMS; CARE; DISEASE
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Background: 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. Methods and Results: Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (N = 81,427; 26,908 HIV+, 54,519 HIV-) were categorized into four groups: HIV- without major depressive disorder (MDD) [reference]; 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). Conclusions: 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.