In HIV, COPD Raises Risk for Heart Attack

Individuals with HIV who also have chronic obstructive pulmonary disease (COPD) are at an increased risk for myocardial infarction (MI)—especially for type 2 MI in the setting of sepsis/bacteremia. This finding is according to a new study that was presented at the Conference on Retroviruses and Opportunistic Infections.

Lead author Dr Kristina Crothers, from University of Washington, presented the study at the conference on March 5.

To determine the relationship between COPD and MI in individuals with HIV, the researchers analyzed data on 25,509 participants with HIV from across 6 sites in the CFAR Network of Integrated Clinical Systems (CNICS) cohort.

In all, 423 had moderate to severe COPD, which was defined based on an algorithm the researchers had previously validated against spirometry, requiring COPD diagnosis codes and a 90-day or more continuous supply of long-acting COPD controller medications.

MIs among the participants were determined by 2 reviewers (3 if there were discrepancies) and were also categorized by type and, for type 2 MI, cause. In all, 698 of the participants were identified as having had an MI, 294 of which were type 2 MI.

After adjusting for factors such as HIV viral load, CD4 count, age, and smoking status, the researchers determined that COPD was independently associated with a significantly increased risk of MI.

While the association was significant for both types of MIs in unadjusted analyses, only the association with type 2 MI was found in adjusted analyses. This association was particularly notable for type 2 MI due to sepsis/bacteremia.

“COPD severity, inadequate disease control, and/or exacerbations can contribute to supply-demand mismatch; and COPD increases risk for pneumonia, a common cause of sepsis,” the researchers concluded. “Further investigation is required to understand mechanisms for this association and to optimize preventative and therapeutic strategies.”

—Colleen Murphy

Reference:

Crothers K, Harding BN, Whitney BM, et al. COPD and the risk for myocardial infarction by type in people living with HIV. Paper presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle, WA. http://www.croiconference.org/sessions/copd-and-risk-myocardial-infarction-type-people-living-hiv. Accessed March 7, 2019.