White Jessica R, Chang Chung-Chou H, So-Armah Kaku A, Stewart Jesse C, Gupta Samir K, Butt Adeel A, Gibert Cynthia L, Rimland David, Rodriguez-Barradas Maria C, Leaf David A, Bedimo Roger J, Gottdiener John S, Kop Willem J, Gottlieb Stephen S, Budoff Matthew J, Khambaty Tasneem, Tindle Hilary A, Justice Amy C, Freiberg Matthew S
From Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, PA (J.R.W.); Department of Medicine, University of Pittsburgh School of Medicine, PA (C.-C.H.C.); Department of Medicine, Boston University, MA (K.A.S.-A.); Department of Psychology, Indiana University-Purdue University Indianapolis (J.C.S., T.K.); Department of Medicine, Indiana University School of Medicine, Indianapolis (S.K.G.); Hamad Healthcare Quality Institute, Doha, Qatar (A.A.B.); Hamad Medical Corporation, Doha, Qatar (A.A.B.); VA Medical Center, Washington, DC (C.L.G.); Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA (D.R.); Atlanta VA Medical Center, Decatur, GA (D.R.); Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX (M.C.R.-B.); UCLA School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, CA (D.A.L.); Department of Medicine, VA North Texas Health Care System, Dallas (R.J.B.); Division of Cardiology, University of Maryland Medical Center, Baltimore (J.S.G.); Department of Medical and Clinical Psychology, Tilburg University, The Netherlands (W.J.K.); Department of Medicine, University of Maryland School of Medicine, Baltimore (S.S.G.); Los Angeles Biomedical Research Institute, Torrance, CA (M.J.B.); Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.T.); Yale University School of Medicine, New Haven, CT (A.C.J.); Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center, CT (A.C.J.); and Cardiovascular Medicine Division, Vanderbilt University School of Medicine and Tennessee Valley Healthcare System, Nashville, TN (M.S.F.).
Circulation. 2015 Oct 27;132(17):1630-8. doi: 10.1161/CIRCULATIONAHA.114.014443. Epub 2015 Sep 10.
Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). 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: 26 908 HIV+, 54 519 without HIV [HIV-]) were categorized into 4 groups: HIV- without major depressive disorder (MDD) [reference], HIV- with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% confidence interval [CI], 8.20-10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95% CI, 1.45-1.95) compared with HIV- participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV- and HIV+ participants (adjusted hazard ratio, 1.21; 95% CI, 1.06-1.37; and adjusted hazard ratio, 1.29; 95% CI, 1.11-1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95% CI, 0.58-0.99).
Our study is the first to suggest that 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.
HIV感染和抑郁症均与心力衰竭（HF）风险增加相关。抑郁症是一种常见的合并症，可能会进一步增加HIV感染成人（HIV+）发生HF的风险。我们评估了HIV、抑郁症与HF发病之间的关联。
退伍军人老龄化队列研究（VACS）中基线时无心血管疾病的参与者（n = 81427：26908例HIV+，54519例无HIV感染[HIV-]）被分为4组：无重度抑郁症（MDD）的HIV-组[参照组]、患有MDD的HIV-组、无MDD的HIV+组和患有MDD的HIV+组。使用医疗记录中的国际疾病分类第九版编码来确定MDD和主要结局HF。经过5.8年的随访，每1000人年的HF发生率在患有MDD的HIV+参与者中最高（9.32；95%置信区间[CI]，8.20 - 10.6）。在Cox比例风险模型中，与无MDD的HIV-参与者相比，患有MDD的HIV+参与者发生HF的风险显著更高（调整后风险比，1.68；95% CI，1.45 - 1.95）。在针对HIV-和HIV+参与者的单独完全调整模型中，MDD与HF相关（调整后风险比分别为1.21；95% CI，1.06 - 1.37；以及调整后风险比，1.29；95% CI，1.11 - 1.51）。在患有MDD的人群中，基线时使用抗抑郁药与HF事件发病风险较低相关（调整后风险比，0.76；95% CI，0.58 - 0.99）。
我们的研究首次表明，MDD是HIV+成人发生HF的独立危险因素。这些结果强化了在HIV+患者中识别和管理MDD的重要性。未来的研究必须阐明将HIV、MDD、抗抑郁药和HF联系起来的机制，并确定降低同时患有HIV和MDD者HF发病率和死亡率的干预措施。
