Association of C-Reactive Protein and HIV Infection With... : JAIDS Journal of Acquired Immune Deficiency Syndromes (original) (raw)

Clinical Science

Association of C-Reactive Protein and HIV Infection With Acute Myocardial Infarction

Triant, Virginia A MD, MPH*†‡; Meigs, James B MD, MPH§; Grinspoon, Steven K MD‡

From the *Division of Infectious Diseases, Brigham and Women's Hospital (BWH); †Division of Infectious Diseases; ‡MGH Program in Nutritional Metabolism; and §the General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Received for publication July 14, 2008; accepted February 4, 2009.

Funded in part by the MGH Clinical Research Program, T32 AI07387 (V.A.T.); K01 AI073109 (V.A.T.); K24 DK080140 (J.B.M.); and K24 DK064545 (S.K.G.).

Correspondence to: Steven K. Grinspoon, MD, Program in Nutritional Metabolism, Massachusetts General Hospital, 55 Fruit St, Longfellow 207, Boston, MA 02114 (e-mail: [email protected]).

JAIDS Journal of Acquired Immune Deficiency Syndromes 51(3):p 268-273, July 2009. | DOI: 10.1097/QAI.0b013e3181a9992c

Abstract

Objective:

To investigate whether elevated C-reactive protein (CRP) levels and HIV infection are independently associated with acute myocardial infarction (AMI) among patients receiving care in a large US health care system.

Methods:

Analyses included patients receiving care in the Partners HealthCare System between January 1997 and December 2006, with a most recent CRP less than 3 years and more than 1 week before AMI. Over this period, 70,357 (487 HIV and 69,870 non-HIV) patients met these criteria, from the background population of 1,648,687 patients followed in the system. We included both CRP and high-sensitivity CRP and defined elevated CRP based on the normal range of the assay used. We used multivariate logistic regression analysis to test the association of elevated CRP and HIV with AMI after adjustment for demographic and other cardiovascular covariates, including hypertension, diabetes, and dyslipidemia.

Results:

In univariate analyses, elevated CRP and HIV were each significantly associated with AMI [odds ratio (OR) 2.51; 95% confidence interval (CI) 2.27 to 2.78; P < 0.0001 for elevated CRP and OR 2.07; 95% CI 1.31 to 3.10; P = 0.001 for HIV]. In a combined model including CRP category and HIV status, elevated CRP (OR 2.50; 95% CI 2.26 to 2.77; P < 0.0001) and HIV (OR 1.74; 95% CI 1.10 to 2.61; P = 0.01) were both independently associated with AMI. In a fully adjusted model controlling for age, sex, race, hypertension, diabetes, and dyslipidemia, both elevated CRP (OR 2.13; 95% CI 1.92 to 2.37; P < 0.0001) and HIV (OR 1.93; 95% CI 1.21 to 2.93; P = 0.004) remained independently associated with AMI. Compared with patients with normal CRP and without HIV, the OR for AMI was increased more than 4-fold among patients with HIV and elevated CRP.

Conclusions:

Elevated CRP and HIV are independently associated with increased AMI risk, and patients with HIV with increased CRP have a markedly increased relative risk of AMI. Measurement of CRP may be useful in the cardiovascular risk assessment of patients with HIV.