Sex disparities of myocardial infarction in individuals with HIV across Europe and Australia: a multinational cohort study
N Jaschinski, A Jiamsakul, J Reekie, B Neesgaard, K Petoumenos, F Boccara, L RyomAbstract
Background
Women with HIV comprise over half the global HIV population and face a disproportionately high myocardial infarction (MI) risk compared to women without HIV. Yet research on MI presentation and management in this population remains limited, with most studies concluding several years ago or confined to single countries.
Purpose
To address potential disparities in equitable cardiovascular (CV) care, this study utilised a large, geographically diverse cohort to characterise MI in women and men with HIV.
Method
RESPOND is a multinational cohort collaboration with rigorous validation of MI events and systematic CV risk factor ascertainment. We followed adults with HIV in RESPOND from baseline (latest of 1 Jan 2012 or local cohort enrolment) until first type I MI, death, last follow-up, or 31 Dec 2023. MI presentation (symptoms, type of ECG changes), risk factors at MI and MI management (invasive CV procedures, secondary prevention medication) in women and men were summarised using descriptive statistics.
Results
At baseline, a higher proportion of women (n=9345) than men (n=28585) had acquired HIV through intravenous drugs (26.9% vs 12.8%) and presented with prior AIDS (37.3% vs 25.9%), chronic kidney disease (6.0% vs 3.3%) and unsuppressed HIV viral load (>200 copies/mL; 26.9% vs 17.2%). During follow-up, MI occurred in 0.5% of women and 1.0% of men (total n=334 MIs with detailed clinical data available). Median age at MI was similar between women and men (58 [IQR 51-63] vs 57 [IQR 51-65] years). ST-elevation MI (STEMI) occurred in 18 women (39.1%) and 132 men (45.8%); non-ST-elevation MIs (NSTEMI) or MI with unknown/no ECG in 28 women (60.9%) and 156 men (54.2%). Across types of ECG changes, a higher proportion of women than men experienced atypical symptoms at MI event (atypical pain, acute heart failure, shock, syncope, dyspnoea without chest pain or cardiac disease except ischaemic heart disease) while fewer women tended to receive an invasive CV procedure within 72 hours (Table). A lower proportion of women than men with NSTEMI or MI with unknown/no ECG used antihypertensive, or lipid-lowering drugs while a higher proportion of women with STEMI used secondary prevention medication at or within 31 days of the MI. Among STEMIs, a higher proportion of women than men were obese (16.7% vs 11.4%) but a lower proportion were current smokers (38.9% vs 48.5%). Among NSTEMI or MI with unknown/no ECG, more women than men were obese (17.9% vs 5.6%) and smokers (50.0% vs 40.4%). HIV markers were similar across groups and by sex.
Conclusion
In this large cohort of individuals with HIV in Europe and Australia, a higher crude proportion of women presented with atypical symptoms and a lower proportion received invasive or guideline-recommended medical therapies for NSTEMI. Whilst these findings require further exploration in adjusted models, they could suggest potential sex-based treatment gap requiring greater awareness.Abstract_Table_MI_sex_HIV