Depression and human immunodeficiency virus infection are risk factors for incident heart failure among veterans: Veterans Aging Cohort Study.

J.R. White, C.C. Chang, K.A. So-Amah, J.C. Stewart, S.K. Gupta, A.A. Butt, C.L. Gibert, D. Rimland, M.C. Rodriguez-Barradas, D.A. Leaf, R.J. Bedimo, J.S. Gottdiener, W.J. Kop, S.S. Gottlieb, M.J. Budoff, T. Khambaty, H.A. Tindle, A.C. Justice, M.S. Freiberg

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Abstract

Background
Both HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF.
Methods and Results
Veterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (n=81 427: 26 908 HIV+, 54 519 without HIV [HIV−]) were categorized into 4 groups: HIV− without major depressive disorder (MDD) [reference], HIV− with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% confidence interval [CI], 8.20–10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95% CI, 1.45–1.95) compared with HIV− participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV− and HIV+ participants (adjusted hazard ratio, 1.21; 95% CI, 1.06–1.37; and adjusted hazard ratio, 1.29; 95% CI, 1.11–1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95% CI, 0.58–0.99).
Conclusions
Our study is the first to suggest that MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.
Keywords: depression, epidemiology, heart failure, HIV
Original languageEnglish
Pages (from-to)1630-1638
JournalCirculation
Volume132
Issue number17
DOIs
Publication statusPublished - 2015

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Veterans
Virus Diseases
Major Depressive Disorder
Depression
Confidence Intervals
International Classification of Diseases

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White, J. R., Chang, C. C., So-Amah, K. A., Stewart, J. C., Gupta, S. K., Butt, A. A., ... Freiberg, M. S. (2015). Depression and human immunodeficiency virus infection are risk factors for incident heart failure among veterans: Veterans Aging Cohort Study. Circulation, 132(17), 1630-1638. https://doi.org/10.1161/CIRCULATIONAHA.114.014443
White, J.R. ; Chang, C.C. ; So-Amah, K.A. ; Stewart, J.C. ; Gupta, S.K. ; Butt, A.A. ; Gibert, C.L. ; Rimland, D. ; Rodriguez-Barradas, M.C. ; Leaf, D.A. ; Bedimo, R.J. ; Gottdiener, J.S. ; Kop, W.J. ; Gottlieb, S.S. ; Budoff, M.J. ; Khambaty, T. ; Tindle, H.A. ; Justice, A.C. ; Freiberg, M.S. / Depression and human immunodeficiency virus infection are risk factors for incident heart failure among veterans : Veterans Aging Cohort Study. In: Circulation. 2015 ; Vol. 132, No. 17. pp. 1630-1638.
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title = "Depression and human immunodeficiency virus infection are risk factors for incident heart failure among veterans: Veterans Aging Cohort Study.",
abstract = "BackgroundBoth HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF.Methods and ResultsVeterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (n=81 427: 26 908 HIV+, 54 519 without HIV [HIV−]) were categorized into 4 groups: HIV− without major depressive disorder (MDD) [reference], HIV− with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95{\%} confidence interval [CI], 8.20–10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95{\%} CI, 1.45–1.95) compared with HIV− participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV− and HIV+ participants (adjusted hazard ratio, 1.21; 95{\%} CI, 1.06–1.37; and adjusted hazard ratio, 1.29; 95{\%} CI, 1.11–1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95{\%} CI, 0.58–0.99).ConclusionsOur study is the first to suggest that MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.Keywords: depression, epidemiology, heart failure, HIV",
author = "J.R. White and C.C. Chang and K.A. So-Amah and J.C. Stewart and S.K. Gupta and A.A. Butt and C.L. Gibert and D. Rimland and M.C. Rodriguez-Barradas and D.A. Leaf and R.J. Bedimo and J.S. Gottdiener and W.J. Kop and S.S. Gottlieb and M.J. Budoff and T. Khambaty and H.A. Tindle and A.C. Justice and M.S. Freiberg",
year = "2015",
doi = "10.1161/CIRCULATIONAHA.114.014443",
language = "English",
volume = "132",
pages = "1630--1638",
journal = "Circulation: Journal of the American Heart Association",
issn = "0009-7322",
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number = "17",

}

White, JR, Chang, CC, So-Amah, KA, Stewart, JC, Gupta, SK, Butt, AA, Gibert, CL, Rimland, D, Rodriguez-Barradas, MC, Leaf, DA, Bedimo, RJ, Gottdiener, JS, Kop, WJ, Gottlieb, SS, Budoff, MJ, Khambaty, T, Tindle, HA, Justice, AC & Freiberg, MS 2015, 'Depression and human immunodeficiency virus infection are risk factors for incident heart failure among veterans: Veterans Aging Cohort Study.', Circulation, vol. 132, no. 17, pp. 1630-1638. https://doi.org/10.1161/CIRCULATIONAHA.114.014443

Depression and human immunodeficiency virus infection are risk factors for incident heart failure among veterans : Veterans Aging Cohort Study. / White, J.R.; Chang, C.C.; So-Amah, K.A.; Stewart, J.C.; Gupta, S.K.; Butt, A.A.; Gibert, C.L.; Rimland, D.; Rodriguez-Barradas, M.C.; Leaf, D.A.; Bedimo, R.J.; Gottdiener, J.S.; Kop, W.J.; Gottlieb, S.S.; Budoff, M.J.; Khambaty, T.; Tindle, H.A.; Justice, A.C.; Freiberg, M.S.

In: Circulation, Vol. 132, No. 17, 2015, p. 1630-1638.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Depression and human immunodeficiency virus infection are risk factors for incident heart failure among veterans

T2 - Veterans Aging Cohort Study.

AU - White, J.R.

AU - Chang, C.C.

AU - So-Amah, K.A.

AU - Stewart, J.C.

AU - Gupta, S.K.

AU - Butt, A.A.

AU - Gibert, C.L.

AU - Rimland, D.

AU - Rodriguez-Barradas, M.C.

AU - Leaf, D.A.

AU - Bedimo, R.J.

AU - Gottdiener, J.S.

AU - Kop, W.J.

AU - Gottlieb, S.S.

AU - Budoff, M.J.

AU - Khambaty, T.

AU - Tindle, H.A.

AU - Justice, A.C.

AU - Freiberg, M.S.

PY - 2015

Y1 - 2015

N2 - BackgroundBoth HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF.Methods and ResultsVeterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (n=81 427: 26 908 HIV+, 54 519 without HIV [HIV−]) were categorized into 4 groups: HIV− without major depressive disorder (MDD) [reference], HIV− with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% confidence interval [CI], 8.20–10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95% CI, 1.45–1.95) compared with HIV− participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV− and HIV+ participants (adjusted hazard ratio, 1.21; 95% CI, 1.06–1.37; and adjusted hazard ratio, 1.29; 95% CI, 1.11–1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95% CI, 0.58–0.99).ConclusionsOur study is the first to suggest that MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.Keywords: depression, epidemiology, heart failure, HIV

AB - BackgroundBoth HIV and depression are associated with increased heart failure (HF) risk. Depression, a common comorbidity, may further increase the risk of HF among adults with HIV infection (HIV+). We assessed the association between HIV, depression, and incident HF.Methods and ResultsVeterans Aging Cohort Study (VACS) participants free from cardiovascular disease at baseline (n=81 427: 26 908 HIV+, 54 519 without HIV [HIV−]) were categorized into 4 groups: HIV− without major depressive disorder (MDD) [reference], HIV− with MDD, HIV+ without MDD, and HIV+ with MDD. International Classification of Diseases, Ninth Revision codes from medical records were used to determine MDD and the primary outcome, HF. After 5.8 years of follow-up, HF rates per 1000 person-years were highest among HIV+ participants with MDD (9.32; 95% confidence interval [CI], 8.20–10.6). In Cox proportional hazards models, HIV+ participants with MDD had a significantly higher risk of HF (adjusted hazard ratio, 1.68; 95% CI, 1.45–1.95) compared with HIV− participants without MDD. MDD was associated with HF in separate fully adjusted models for HIV− and HIV+ participants (adjusted hazard ratio, 1.21; 95% CI, 1.06–1.37; and adjusted hazard ratio, 1.29; 95% CI, 1.11–1.51, respectively). Among those with MDD, baseline antidepressant use was associated with lower risk of incident HF events (adjusted hazard ratio, 0.76; 95% CI, 0.58–0.99).ConclusionsOur study is the first to suggest that MDD is an independent risk factor for HF in HIV+ adults. These results reinforce the importance of identifying and managing MDD among HIV+ patients. Future studies must clarify mechanisms linking HIV, MDD, antidepressants, and HF and identify interventions to reduce HF morbidity and mortality in those with both HIV and MDD.Keywords: depression, epidemiology, heart failure, HIV

U2 - 10.1161/CIRCULATIONAHA.114.014443

DO - 10.1161/CIRCULATIONAHA.114.014443

M3 - Article

C2 - 26358261

VL - 132

SP - 1630

EP - 1638

JO - Circulation: Journal of the American Heart Association

JF - Circulation: Journal of the American Heart Association

SN - 0009-7322

IS - 17

ER -