HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome

Franck Boccara, Murielle Mary-Krause, Valérie Potard, Emmanuel Teiger, Sylvie Lang, Nadjib Hammoudi, Marion Chauvet, Stéphane Ederhy, Laurie Dufour-Soulat, Yann Ancedy, Pascal Nhan, Saroumadi Adavane, Ph Gabriel Steg, Christian Funck-Brentano, Dominique Costagliola, Ariel Cohen, PACS‐HIV (Prognosis of Acute Coronary Syndrome in HIV‐Infected Patients) Investigators †, S Weber, K Wahbi, P Beaufils, P Henri, G Sideris, D Thomas, G Montalescot, F Beygui, C Meuleman, S Janower, F Raoux, G Dufaitre, N Benyounes, P L Michel, B Petillon, N Hammoudi, P Gueret, J L Dubois-Rande, E Teiger, P Lim, M Slama, P Colin, C Saudubray, O Dubourg, O Milleron, B Gallet, F Duclos, S Godard, L Fuchs, V Dormagen, P Lewy, S Cattan, O Nallet, G Grollier, J Shayne, J E Wolf, Y Cottin, J Machecourt, H Bouvaist, G Finet, B De Breyne, J N Trochu, M Baudouy, E Ferrari, M Benhamou, J Allal, D Coisne, H Le Breton, M Bedossa, J Puel, M Elbaz, L Larifla, S Matheron, R Landman, G Fremont, G Spiridon, P Blanche, J P Morini, D Sicard, V Zeller, D Batisse, P Clevenbergh, G Cessot, E Dohin, M A Valantin, S Khelifa, P M Girard, F Lallemand, B Lefebvre, J P Laporte, J L Meynard, H Bideault, O Picard, M C Meyohas, P Campa, J Tredup, L Fonquernie, G Raguin, J M Molina, A Furco, S Gharakanian, J P Vincensini, J B Guiard-Schmid, G Pialoux, B Cardon, A S Lascaux, F Chaix, P Lesprit, R Fior, F Boue, C Dupont, C Bellier, A Blanc, T Lambert, T Touahri, G Force, P de Truchis, M A Compagnucci-Seguenot, I Cahitte, L Roudière, M E Techer, P Thelpin, D Troisvallets, A Lepretre, M Echard, Y Le Mercier, D Houlbert, S Dargere, C Bazin, R Verdon, B De Goer, M Duong, P Chavanet, E Gozlan, P Leclercq, F Brunel-Dal Mas, J Durant, P Heudier, C Brunet-François, G Le Moal, J M Chapplin, C Arvieux, G Chaumentin, B Guerin, E Bonnet, Y Poinsignon, F Boulard, I De Lacroix, M T Goerger-Sow, M Kirstetter, M Volstein, F Laylavoix, X Copin, C Ceppi, Franck Boccara, Murielle Mary-Krause, Valérie Potard, Emmanuel Teiger, Sylvie Lang, Nadjib Hammoudi, Marion Chauvet, Stéphane Ederhy, Laurie Dufour-Soulat, Yann Ancedy, Pascal Nhan, Saroumadi Adavane, Ph Gabriel Steg, Christian Funck-Brentano, Dominique Costagliola, Ariel Cohen, PACS‐HIV (Prognosis of Acute Coronary Syndrome in HIV‐Infected Patients) Investigators †, S Weber, K Wahbi, P Beaufils, P Henri, G Sideris, D Thomas, G Montalescot, F Beygui, C Meuleman, S Janower, F Raoux, G Dufaitre, N Benyounes, P L Michel, B Petillon, N Hammoudi, P Gueret, J L Dubois-Rande, E Teiger, P Lim, M Slama, P Colin, C Saudubray, O Dubourg, O Milleron, B Gallet, F Duclos, S Godard, L Fuchs, V Dormagen, P Lewy, S Cattan, O Nallet, G Grollier, J Shayne, J E Wolf, Y Cottin, J Machecourt, H Bouvaist, G Finet, B De Breyne, J N Trochu, M Baudouy, E Ferrari, M Benhamou, J Allal, D Coisne, H Le Breton, M Bedossa, J Puel, M Elbaz, L Larifla, S Matheron, R Landman, G Fremont, G Spiridon, P Blanche, J P Morini, D Sicard, V Zeller, D Batisse, P Clevenbergh, G Cessot, E Dohin, M A Valantin, S Khelifa, P M Girard, F Lallemand, B Lefebvre, J P Laporte, J L Meynard, H Bideault, O Picard, M C Meyohas, P Campa, J Tredup, L Fonquernie, G Raguin, J M Molina, A Furco, S Gharakanian, J P Vincensini, J B Guiard-Schmid, G Pialoux, B Cardon, A S Lascaux, F Chaix, P Lesprit, R Fior, F Boue, C Dupont, C Bellier, A Blanc, T Lambert, T Touahri, G Force, P de Truchis, M A Compagnucci-Seguenot, I Cahitte, L Roudière, M E Techer, P Thelpin, D Troisvallets, A Lepretre, M Echard, Y Le Mercier, D Houlbert, S Dargere, C Bazin, R Verdon, B De Goer, M Duong, P Chavanet, E Gozlan, P Leclercq, F Brunel-Dal Mas, J Durant, P Heudier, C Brunet-François, G Le Moal, J M Chapplin, C Arvieux, G Chaumentin, B Guerin, E Bonnet, Y Poinsignon, F Boulard, I De Lacroix, M T Goerger-Sow, M Kirstetter, M Volstein, F Laylavoix, X Copin, C Ceppi

Abstract

Background It is unclear whether HIV infection affects the long-term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV-uninfected (HIV-) patients, and to identify determinants of cardiovascular prognosis. Methods and Results Consecutive PLHIV and matched HIV- patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36-month follow-up. A total of 103 PLHIV and 195 HIV- patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow-up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- patients (17.8% and 15.1%, P=0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67-3.82 [P=0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32-30.21 [P=0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%; P=0.01) and had smaller total cholesterol decreases (-22.3 versus -35.0 mg/dL; P=0.04). Conclusions Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- individuals, PLHIV had a higher rate of recurrent ACS. Registration URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT00139958.

Keywords: HIV; acute coronary syndrome; coronary artery disease; dyslipidemia; heart disease.

Conflict of interest statement

Dr Boccara reports research grants from Amgen; lecture fees from Janssen, Gilead, ViiV Healthcare, Amgen, Sanofi, MSD, and Servier outside the submitted work. Dr Costagliola reports HIV grants from Janssen and MSD France; personal fees from Janssen, MSD France, and Gilead for lectures; personal fees from Innavirvax, and Merck Switzerland for consultancy, outside the submitted work. Dr Hammoudi reports research grants to the Institution or consulting/lecture fees from Philips, Bayer, Laboratoires Servier, Novartis Pharma, Astra Zeneca, Bristol Myers Squibb, MSD, Fédération Française de Cardiologie, and ICAN outside the submitted work. Dr Steg reports research grants from Bayer, Merck, Sanofi, and Servier; speaking or consulting fees from Amarin, Amgen, AstraZeneca, Bayer/Janssen, Boehringer Ingelheim, Bristol‐Myers Squibb, Lilly, Merck, Novartis, Novo Nordisk, Pfizer, Regeneron, Sanofi, and Servier, Dr Cohen reports a research grant from RESICARD, and consultant/advisory board fees from Amgen, AstraZeneca, Bayer, Bristol‐Myers Squibb, Boehringer Ingelheim, Novartis, and Pfizer. The remaining authors have no disclosures to report.

Figures

Figure 1. Kaplan–Meier plots by HIV status.
Figure 1. Kaplan–Meier plots by HIV status.
A, Major adverse cardiac and cerebrovascular events (MACCE). B, Cardiovascular death. C, Recurrent coronary revascularization. D, Stroke. E, Recurrent acute coronary syndrome (ACS). HR indicates hazard ratio; and PLHIV, people living with HIV.
Figure 2. Kaplan–Meier plots by HIV status.
Figure 2. Kaplan–Meier plots by HIV status.
A, Target lesion revascularization (TLR). B, Target vessel revascularization (TVR). C, Target vessel failure (TVF). HR indicates hazard ratio; and PLHIV, people living with HIV.

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