HIV Patients With Depression Have Greater Risk of Myocardial Infarction Interview with:
Matthew S Freiberg, MD, MSc
Cardiovascular Medicine Division, Vanderbilt University School of Medicine
Tennessee Valley Geriatric Research Education and Clinical Center, Nashville  TN
Tasneem Khambaty, PhD
Department of Psychology, University of Miami, Coral Gables, Florida
Jesse C. Stewart, PhD
Department of Psychology, Indiana University–Purdue University , Indianapolis, Indianapolis What is the background for this study?

Response: Due to highly effective antiretroviral therapy, people with HIV are living longer. Unfortunately, these HIV-infected individuals remain at a higher risk for other chronic diseases, with cardiovascular disease (CVD) being one of the leading cause of death in this population. In the general population, depressive disorders, such as major depressive disorder (MDD) and dysthymic disorder, are associated with increased risk of new-onset CVD. Given that roughly 24-40% of HIV-infected individuals have a depressive disorder, we examined whether MDD and dysthymic disorder are also associated with an increased risk of new-onset CVD in people with HIV. What are the main findings?

Response: In our sample of over 26,000 HIV-infected veterans initially free of CVD, we found that major depressive disorder was associated with an increased risk of new-onset CVD over a 6-year period. Specifically, HIV-infected adults with MDD had a 30% greater risk of suffering an acute myocardial infarction (heart attack) during follow-up than did HIV-infected adults without MDD, beyond the risk conferred by demographics, traditional CVD risk factors, and HIV-specific factors. Dysthymic disorder, a milder but more chronic form of depression, was not associated with greater risk of acute myocardial infarction. What should readers take away from your report?

Response: Our results indicate that HIV-infected adults with major depressive disorder have a greater risk of acute myocardial infarction than HIV-infected adults without MDD. Therefore, our findings raise the possibility that MDD may be a risk factor for CVD in the HIV-infected population, similar to in the general population. Our findings also highlight the need for clinical trials designed to evaluate the effect of high-quality depression treatment on CVD risk in HIV-infected adults. Ultimately, this line of research could identify a novel CVD risk factor (depression) and a new CVD primary prevention approach (depression treatment), which could help to reduce CVD morbidity and mortality in people with HIV. What recommendations do you have for future research as a result of this study?

1. Considering the dearth of research in this area, additional studies are needed to replicate and extend our findings in other samples, such as non-veteran samples.

2. The mechanisms underlying the prospective association between depression and new-onset CVD in the HIV-infected population need to be understood.

3. There is a need for clinical trials designed to evaluate the effect of high-quality depression treatment on CVD risk markers and new-onset CVD events in HIV-infected adults with depression. Thank you for your contribution to the community.

Citation:Tasneem Khambaty, Jesse C. Stewart, Samir K. Gupta, Chung-Chou H. Chang, Roger J. Bedimo, Matthew J. Budoff, Adeel A. Butt, Heidi Crane, Cynthia L. Gibert, David A. Leaf, David Rimland, Hilary A. Tindle, Kaku A. So-Armah, Amy C. Justice, Matthew S. Freiberg. Association Between Depressive Disorders and Incident Acute Myocardial Infarction in Human Immunodeficiency Virus–Infected Adults. JAMA Cardiology, 2016; DOI:10.1001/jamacardio.2016.2716

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on August 25, 2016 by Marie Benz MD FAAD