Gender differences in the use of cardiovascular interventions in HIV-positive persons: the D:A:D Study

Camilla I. Hatleberg*, Lene Ryom, Wafaa El-Sadr, Amanda Mocroft, Peter Reiss, Stephane De Wit, Francois Dabis, Christian Pradier, Antonella d'Arminio Monforte, Helen Kovari, Matthew Law, Jens D. Lundgren, Data Collection of Adverse Events of Anti‐HIV drugs (D:A:D) Study group, Inge van Loo, Caroline A. Sabin

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Introduction: There is paucity of data related to potential gender differences in the use of interventions to prevent and treat cardiovascular disease (CVD) among HIV-positive individuals. We investigated whether such differences exist in the observational D:A:D cohort study.

Methods: Participants were followed from study enrolment until the earliest of death, six months after last visit or February 1, 2015. Initiation of CVD interventions [lipid-lowering drugs (LLDs), angiotensin-converting enzyme inhibitors (ACEIs), anti-hypertensives, invasive cardiovascular procedures (ICPs) were investigated and Poisson regression models calculated whether rates were lower among women than men, adjusting for potential confounders.

Results: Women (n = 12,955) were generally at lower CVD risk than men (n = 36,094). Overall, initiation rates of CVD interventions were lower in women than men; LLDs: incidence rate 1.28 [1.21, 1.35] vs. 2.40 [2.34, 2.46]; ACEIs: 0.88 [0.82, 0.93] vs. 1.43 [1.39, 1.48]; anti-hypertensives: 1.40 [1.33, 1.47] vs. 1.72 [1.68, 1.77] and ICPs: 0.08 [0.06, 0.10] vs. 0.30 [0.28, 0.32], and this was also true for most CVD interventions when exclusively considering periods of follow-up for which individuals were at high CVD risk. In fully adjusted models, women were less likely to receive CVD interventions than men (LLDs: relative rate 0.83 [0.78, 0.88]; ACEIs: 0.93 [0.86, 1.01]; ICPs: 0.54 [0.43, 0.68]), except for the receipt of anti-hypertensives (1.17 [1.10, 1.25]).

Conclusion: The use of most CVD interventions was lower among women than men. Interventions are needed to ensure that all HIV-positive persons, particularly women, are appropriately monitored for CVD and, if required, receive appropriate CVD interventions.

Original languageEnglish
Article number25083
Number of pages13
JournalJournal of the International AIDS Society
Volume21
Issue number3
DOIs
Publication statusPublished - Mar 2018

Keywords

  • Cardiovascular disease
  • gender
  • cardiovascular disease interventions
  • cohort studies
  • HIV
  • women
  • myocardial infarction
  • stroke
  • ACUTE MYOCARDIAL-INFARCTION
  • ACUTE CORONARY SYNDROME
  • IN-HOSPITAL MORTALITY
  • SEX-DIFFERENCES
  • HEART-DISEASE
  • RISK-FACTORS
  • SYMPTOM PRESENTATION
  • CLINICAL PRESENTATION
  • GENERAL-POPULATION
  • INFECTED PATIENTS

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