We’ve known for quite some time that for a person living with HIV but treating it with modern antiretroviral therapy, a heart attack is a much greater threat than an opportunistic infection.
And now we know that when you put depression into the mix, the heart attack risk is even greater.
While the findings aren’t surprising because they mirror a link between depression and heart attack risk in the general population, the paper published online this morning in JAMA Cardiology is cause for concern. That’s because people with HIV already are at far greater risk of having a heart attack than the general population, due in part to the heightened state of inflammation HIV causes in the body.
“Our findings raise the possibility that, similar to the general population, major depressive disorder may be independently associated with incident atherosclerotic cardiovascular disease in the HIV-infected population,” the authors wrote. “Considering the dearth of research in this area, future epidemiologic and mechanistic studies that include women and non-VA populations with HIV are needed.”
Researchers from Tennessee’s Vanderbilt University followed more than 26,000 HIV-infected veterans without cardiovascular disease at baseline (1998-2003) participating in the U.S. Department of Veterans Affairs Veterans Aging Cohort Study from April 1, 2003 to Dec. 31, 2009. At baseline, 19 percent of them suffered from major depressive disorder as classified by the International Classification of Diseases codes.
“We report novel evidence that HIV-infected adults with major depressive disorder have a 30 percent increased risk for acute myocardial infarction (a heart attack) than HIV-infected adults without major depressive disorder after adjustment for many potential confounders,” the authors wrote.
Depression a problem among people with HIV
The findings are troubling because not only is heart disease far more prevalent among people with HIV than in the general population (one study showed that the risk is increased by 50 percent), so is depression.
Two years ago, I wrote a story for Healthline News headlined, “People with HIV Suffer from Depression Caused by Pain, Shame, Substance Abuse.” You can read the story by clicking here. I don’t think I ever have received more email from readers than I did for that story, mostly thanking me for bring me the issue to light. People with HIV run twice the risk of depression than the general population, studies show.
Many people with HIV simply are getting older, and older Americans are at greater risk for depression even without a chronic illness. Older people are at greater risk for heart attack, too.
The mean age among people with HIV with major depressive disorder in the Vanderbilt study was 48. The mean age among those without depression was 47.
“It is possible that the presence of major depressive disorder further exacerbates the persistent inflammatory and coagulatory activation already present in HIV, resulting in higher cardiovascular disease event rates,” the authors wrote. “Potential behavioral mechanisms underlying the major depressive disorder incident CVD association are poor health behaviors (eg. smoking and sedentary lifestyle and treatment non-adherence).”
Studies have shown that people who are depressed are less adherent to their HIV medication.
It all adds up to a deadly mix for people with HIV who aren’t taking care of themselves. The authors hope their study stimulates new research for depression treatments among people with HIV.