Association of Syndemic Unhealthy Alcohol Use, Smoking, and Depressive Symptoms on Incident Cardiovascular Disease among Veterans With and Without HIV-Infection

被引:0
作者
Natalie E. Chichetto
Suman Kundu
Matthew S. Freiberg
John R. Koethe
Adeel A. Butt
Stephen Crystal
Kaku A. So-Armah
Robert L. Cook
R. Scott Braithwaite
Amy C. Justice
David A. Fiellin
Maria Khan
Kendall J. Bryant
Julie R. Gaither
Shirish S. Barve
Kristina Crothers
Roger J. Bedimo
Alberta Warner
Hilary A. Tindle
机构
[1] Vanderbilt University Medical Center,Department of Medicine
[2] Veterans Affairs Tennessee Valley Healthcare System,Geriatric Research Education and Clinical Centers (GRECC)
[3] VA Pittsburgh Healthcare System,Department of Medicine
[4] Weill-Cornell Medical College,Health Care Policy, and Aging Research and School of Social Work
[5] Hamad Medical Corporation,Department of Medicine
[6] Institute for Health,Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine
[7] Rutgers University,Department of Population Health
[8] Boston University School of Medicine,Schools of Medicine and Public Health
[9] University of Florida,Division of Gastroenterology, Hepatology, and Nutrition
[10] New York University School of Medicine,Department of Medicine
[11] Yale University,Department of Medicine, David Geffen School of Medicine
[12] Veterans Affairs Connecticut Healthcare System,undefined
[13] National Institute On Alcohol Abuse and Alcoholism,undefined
[14] University of Louisville School of Medicine,undefined
[15] University of Washington,undefined
[16] Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center,undefined
[17] University of California,undefined
来源
AIDS and Behavior | 2021年 / 25卷
关键词
Alcohol; Smoking; Depression; Cardiovascular; HIV;
D O I
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学科分类号
摘要
Unhealthy alcohol use, smoking, and depressive symptoms are risk factors for cardiovascular disease (CVD). Little is known about their co-occurrence – termed a syndemic, defined as the synergistic effect of two or more conditions—on CVD risk in people with HIV (PWH). We used data from 5621 CVD-free participants (51% PWH) in the Veteran’s Aging Cohort Study-8, a prospective, observational study of veterans followed from 2002 to 2014 to assess the association between this syndemic and incident CVD by HIV status. Diagnostic codes identified cases of CVD (acute myocardial infarction, stroke, heart failure, peripheral artery disease, and coronary revascularization). Validated measures of alcohol use, smoking, and depressive symptoms were used. Baseline number of syndemic conditions was categorized (0, 1, ≥ 2 conditions). Multivariable Cox Proportional Hazards regressions estimated risk of the syndemic (≥ 2 conditions) on incident CVD by HIV-status. There were 1149 cases of incident CVD (52% PWH) during the follow-up (median 10.1 years). Of the total sample, 64% met our syndemic definition. The syndemic was associated with greater risk for incident CVD among PWH (Hazard Ratio [HR] 1.87 [1.47–2.38], p < 0.001) and HIV-negative veterans (HR 1.70 [1.35–2.13], p < 0.001), compared to HIV-negative with zero conditions. Among those with the syndemic, CVD risk was not statistically significantly higher among PWH vs. HIV-negative (HR 1.10 [0.89, 1.37], p = .38). Given the high prevalence of this syndemic combined with excess risk of CVD, these findings support linked-screening and treatment efforts.
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页码:2852 / 2862
页数:10
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