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Original Investigation
November 2016

Association Between Depressive Disorders and Incident Acute Myocardial Infarction in Human Immunodeficiency Virus–Infected AdultsVeterans Aging Cohort Study

Author Affiliations
  • 1Department of Psychology, University of Miami, Coral Gables, Florida
  • 2Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis
  • 3Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis
  • 4Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 5Department of Medicine, VA North Texas Health Care System, Dallas
  • 6Los Angeles Biomedical Research Institute, Torrance, California
  • 7VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
  • 8Weill Cornell Medical College, Doha, Qatar, and New York, New York
  • 9Hamad Healthcare Quality Institute and Hamad Medical Corp, Doha, Qatar
  • 10University of Washington School of Medicine, Seattle
  • 11VA Medical Center, Washington, DC
  • 12University of California, Los Angeles School of Medicine and Division of General Medicine, Greater Los Angeles VA Healthcare System, Los Angeles
  • 13Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
  • 14Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
  • 15Division of General Internal Medicine, Boston University, Boston, Massachusetts
  • 16Department of Medicine, Yale University School of Medicine, and VA Connecticut Healthcare System, West Haven Affiliation, New Haven
  • 17Cardiovascular Medicine Division, Vanderbilt University School of Medicine, Nashville, Tennessee
  • 18Tennessee Valley Geriatric Research Education and Clinical Center, Nashville
JAMA Cardiol. 2016;1(8):929-937. doi:10.1001/jamacardio.2016.2716
Key Points

Question  Is depression independently associated with incident atherosclerotic cardiovascular disease (CVD) in the human immunodeficiency virus (HIV)–infected population?

Findings  In this cohort study of 26 144 veterans without CVD, HIV-infected adults with major depressive disorder (MDD) had a greater risk for acute myocardial infarction than HIV-infected adults without MDD after adjustment for many potential confounders.

Meaning  Major depressive disorder may be an independent predictor of incident atherosclerotic CVD in the HIV-infected population.


Importance  With the advent of highly effective antiretroviral therapy and improved survival, human immunodeficiency virus (HIV)–infected people are living longer and are now at an increased risk for cardiovascular disease (CVD). There is an urgent need to identify novel risk factors and primary prevention approaches for CVD in HIV. Although depression is prevalent in HIV-infected adults and is associated with future CVD in the general population, its association with CVD events has not been examined in the HIV-infected population.

Objective  To examine whether depressive disorders are prospectively associated with incident acute myocardial infarction (AMI) in a large cohort of adults with HIV.

Design, Setting, and Participants  Included in this cohort study were 26 144 HIV-infected veterans without CVD at baseline (1998-2003) participating in the US Department of Veterans Affairs Veterans Aging Cohort Study from April 1, 2003, through December 31, 2009. At baseline, 4853 veterans (19%) with major depressive disorder (MDD; International Classification of Diseases, Ninth Revision [ICD-9] codes 296.2 and 296.3) and 2296 (9%) with dysthymic disorder (ICD-9 code 300.4) were identified. The current analysis was conducted from January 2015 to November 2015.

Main Outcomes and Measures  Incident AMI (defined by discharge summary documentation, enzyme/electrocardiography evidence of AMI, inpatient ICD-9 code for AMI (410), or AMI as underlying cause of death [International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code 121]) between the enrollment date and December 31, 2009.

Results  The mean (SD) age of those with MDD was 47.3 (7.9) years and for those without MDD was 48.2 (9.7) years. During 5.8 years of follow-up, 490 AMI events (1.9%) occurred. Baseline MDD was associated with incident AMI after adjusting for demographics (hazard ratio [HR], 1.31; 95% CI, 1.05-1.62), CVD risk factors (HR, 1.29; 95% CI, 1.04-1.60), and HIV-specific factors (HR, 1.30; 95% CI, 1.05-1.62). Further adjustment for hepatitis C, renal disease, substance abuse, and hemoglobin level (HR, 1.25; 95% CI, 1.00-1.56) and antidepressant use (HR, 1.12; 95% CI, 0.87-1.42) attenuated associations. Baseline dysthymic disorder was not associated with incident AMI.

Conclusions and Relevance  We report novel evidence that HIV-infected adults with MDD have a 30% increased risk for AMI than HIV-infected adults without MDD after adjustment for many potential confounders. Our findings raise the possibility that MDD may be independently associated with incident atherosclerotic CVD in the HIV-infected population.