People with HIV (PWH) experience higher lifetime prevalence of major depression and anxiety than the general population. Depression and anxiety have been associated with increased risk of myocardial infarction (MI) in the general population and among PWH but with limited attention on the type of MI among PWH. We examined the association between depression and/or anxiety and incident Type 1 (T1MI) or Type 2 (T2MI) acute MI among PWH.
We examined data from 7 NA-ACCORD clinical cohorts (1997-2017) with adjudicated first MI, regardless of type; outcomes included T1MI (plaque rupture or cardiac intervention) or T2MI (demand ischemia). Baseline was when a participant entered observation for MI. We defined depression or anxiety as a time-varying ICD-coded diagnosis prior to an incident MI; we censored participants at death, loss to follow-up, or first MI (if it was not the outcome type of interest). We used Cox proportional hazard models to estimate the association between depression/anxiety and MI by type, adjusting for sex at birth, age, race/ethnicity, HIV acquisition group, substance use, and traditional and HIV-related risk factors for cardiovascular disease. We performed a test for interaction between depression and anxiety on the risk of MI.
Of the 33,071 study participants followed for 168,846 person-years, 16,351 had a diagnosis of depression or anxiety (5,432 with both), and 16,720 never had a depression or anxiety diagnosis; 495 T1MIs and 374 T2MIs occurred. After adjusting for traditional and HIV-related risk factors, depression was a significant predictor of T1MI (aHR, 1.23 [95% CI, 1.02-1.49]) with a similar effect size and trend towards statistical significance for T2MI (aHR, 1.20 [95% CI, 0.96, 1.51]). Anxiety was not a significant predictor for T1MI (aHR, 0.92 [95% CI, 0.74-1.16]) but was significant for T2MI with a strong effect size (aHR, 1.42 [95% CI, 1.10-1.83]). We found no evidence for interaction between anxiety and depression. Ever smoking was a significant predictor for both T1MI and T2MI, while ever cocaine use and detectable viral load were significant predictors only for T2MI.
Diagnosed depression was a significant predictor of T1MI and suggestive for T2MI among PWH, whereas anxiety was associated only with T2MI. Further understanding of the role for mental health diagnosis and treatment to improve cardiovascular health among PWH is needed, including access to substance use disorder treatment and comorbidity management.