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

• 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
• Journal Title: Circulation
• Volume: Volume 132, Number 17
• Publisher: American Heart Association | 2015-10-27, Pages 1630-1638
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1161/CIRCULATIONAHA.114.014443
• Subjects: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Peripheral Vascular Disease; Cardiovascular System & Cardiology; depression; epidemiology; heart failure; HIV; HIV-INFECTION; CARDIOVASCULAR EVENTS; DISEASE; HEALTH; ASSOCIATION; MECHANISMS; SYSTEM; CARE; ATHEROSCLEROSIS; COMORBIDITIES

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.