Cardiovascular Disease Risk and Falls in Men and Women Living with and Without HIV in MACS/WIHS Combined Cohort Study

Background: We examined the cross-sectional relationship between cardiovascular disease (CVD) risk, history of falls and the number of falls in the past year in the US multicenter MACS/WIHS Combined Cohort Study (2020-2022) of men and women without HIV (MWOH/WWOH) and men and women with HIV (MWH/WWH). Setting/Methods: CVD risk was assessed by pooled cohort equation 10-year risk scores and categorized into four levels. Self-reported falls outcomes (recent fall, not recent fall, one fall, multiple falls) were assessed using a standardized protocol. Odds ratios of falls were measured using multinomial regression models stratified by sex and adjusted for ethnicity, education attainment, alcohol consumption, body-mass index, fall-risk medications, physical activity, and HIV serostatus. Results: There were 2,723 participants, 35% were men (577 MWH, 360 MWOH) with a median age of 58 (IQR: 14) years. Women represented 65% (1,271 WWH, 515 WWOH) with a median age of 55 (IQR: 11) years. In sex stratified multinomial adjusted models, among men, high CVD risk (vs. low risk) was significantly associated with a recent fall (vs. never fall) (aOR: 3.12, 95% CI:1.59 – 6.13) and one fall (vs. no fall) in past year (aOR: 3.66; 95% CI: 1.45 – 9.21). Among women, high CVD risk was only significantly associated with multiple falls (vs. no fall) in past year (aOR: 2.06; 95% CI: 1.24-3.43). Conclusion: Our findings highlight the importance of integrating fall risk assessments into CVD management, particularly for men and women with living with HIV and high CVD risk, and the need for targeted, gender-responsive fall prevention strategies in clinical practice.