Key result
HIV infection was associated with a substantially increased risk of myocardial infarction among current smokers (aIRR 2.83; 95% CI 1.71-4.70), with smoking accounting for 72% of MIs in HIV patients.
Why the study?
Does smoking disproportionately increase the risk of myocardial infarction in HIV-infected individuals compared to the general population?
Cohort (n=16,255)
Does smoking disproportionately increase the risk of myocardial infarction in HIV-infected individuals compared to the general population?
Relative Risk: 2.83 (95% CI 1.71–4.7)
Smoking is associated with a disproportionately higher risk of myocardial infarction in HIV-infected individuals compared to the general population, highlighting the critical importance of smoking cessation in modern HIV care.
May prioritize smoking cessation in HIV; extends evidence on excess MI risk but remains hypothesis-generating.
BACKGROUND: Human immunodeficiency virus-infected individuals have increased risk of myocardial infarction (MI); however, the contribution from smoking and potentiating effects of HIV are controversial. METHODS: From the Danish HIV Cohort Study and the Copenhagen General Population Study, we identified 3251 HIV-infected individuals and 13 004 population controls matched on age and gender. Data on MI were obtained from the National Hospital Registry and the National Registry of Causes of Death. We calculated adjusted incidence rate ratios (aIRR) for risk of MI and population-attributable fractions (PAF) of MI associated with smoking. RESULTS: In never smokers, HIV was not associated with an increased risk of MI (aIRR, 1.01; 95% confidence interval [CI], .41-2.54). In previous and current smokers, HIV was associated with a substantially increased risk of MI (aIRR, 1.78; 95% CI, .75-4.24 and aIRR, 2.83; 95% CI, 1.71-4.70). The PAF associated with ever smoking (previous or current) was 72% (95% CI, 55%-82%) for HIV-infected individuals and 24% (95% CI, 3%-40%) for population controls. If all current smokers stopped smoking, 42% (95% CI, 21%-57%) and 21% (95% CI, 12%-28%) of all MIs could potentially be avoided in these 2 populations. CONCLUSIONS: Smoking is associated with a higher risk of MI in the HIV-infected population than in the general population. Approximately 3 of 4 MIs among HIV-infected individuals are associated with ever smoking compared with only 1 of 4 MIs among population controls. Smoking cessation could potentially prevent more than 40% of MIs among HIV-infected individuals, and smoking cessation should be a primary focus in modern HIV care.
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Rasmussen et al. (2015) conducted a cohort in HIV infection and myocardial infarction (n=16,255). HIV infection (in current smokers) vs. Population controls (current smokers) was evaluated on Myocardial infarction (aIRR 2.83, 95% CI 1.71-4.70). HIV infection was associated with a substantially increased risk of myocardial infarction among current smokers (aIRR 2.83; 95% CI 1.71-4.70), with smoking accounting for 72% of MIs in HIV patients.