Heavy Alcohol Use Increases Risk of Cardiovascular Disease in Men with HIV

		SUMMARY: "Hazardous drinking" and alcohol abuse or dependence were associated with a higher likelihood of cardiovascular disease than infrequent and moderate drinking, even after adjusting for traditional cardiovascular risk factors, use of antiretroviral therapy (ART), and CD4 cell count, according to a large study of older U.S. veterans described in the February 2010 Journal of Acquired Immune Deficiency Syndromes.

By Liz Highleyman

A growing body of evidence indicates that cardiovascular disease is more common among HIV positive people -- and at younger ages -- compared with HIV negative individuals. However, the relative contributions of inflammation due to ongoing HIV infection, side effects of ART, and traditional risk factors such as smoking are not fully understood.

While heavy alcohol consumption is not generally listed among the most common cardiovascular risk factors, it has been linked to heart disease in prior studies of the HIV negative general population.

Matthew Freiberg and fellow investigators with the Veterans Aging Cohort Study (VACS) Project Team sought to determine whether alcohol consumption is associated with cardiovascular disease among HIV positive U.S. veterans.

The researchers analyzed cross-sectional data from 4743 men in the VACS cohort who reported at least some alcohol use, about half of whom were HIV positive veterans and half were demographically similar HIV negative veterans.

Alcohol use was classified as:

	Infrequent and moderate drinking (14 or fewer drinks per week);
	Hazardous drinking (either more than 14 drinks per week, or "binge drinking" of 6 or more drinks on a single occasion at least once a month);
	Alcohol abuse or dependence (alcohol use exceeding the hazardous level, plus other criteria).

Results

	HIV positive and HIV negative men had similar high likelihood of problematic alcohol use, including hazardous drinking (33.2% vs 30.9%) and alcohol abuse or dependence (20.9% vs 26.2%).
	14.6% of HIV positive men had cardiovascular disease, compared with 19.8% of HIV negative participants.
	Among the HIV positive men, hazardous drinking was associated with a significantly higher prevalence of cardiovascular disease compared with infrequent and moderate alcohol use (odds ratio [OR] 1.43, or a 43% increase in risk).
	Alcohol abuse or dependence was also associated with a significantly higher prevalence of cardiovascular disease compared with lighter alcohol use (OR 1.55, or a 55% increase).
	Among only HIV positive men, hazardous drinking increased the risk of congestive heart failure by 74% and alcohol abuse or dependence did so by 99%.
	Within this same group, past alcohol use was associated with a 78% higher risk of stroke.
	Among only HIV negative men, the researchers did not see a significant association between current alcohol use and cardiovascular disease, but past drinkers had a significantly higher risk (OR 1.30, or 30% higher).
	For both HIV positive and HIV negative men, traditional risk factors and kidney disease predicted cardiovascular disease.
	However, the greater risk associated with heavy alcohol use among HIV positive men remained even after adjusting for these other risk factors.

Based on these findings, the study authors concluded, "Among HIV-infected men, hazardous drinking and alcohol abuse and dependence were associated with a higher prevalence of cardiovascular disease compared with infrequent and moderate drinking even after adjusting for traditional cardiovascular disease risk factors, antiretroviral therapy, and CD4 count."

Since the same association did not hold for HIV negative men, they suggested that heavy alcohol use appears to have a more pronounced effect on men with HIV. The underlying reasons for this discrepancy are not clear, but elevated lipid levels associated with heavy alcohol consumption may play a role. In contrast, various studies in the HIV negative population indicate that light drinking -- especially wine -- appears to have a protective effect.

University of Pittsburgh School of Medicine, Pittsburgh, PA; University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Boston University School of Medicine, Boston, MA; Lexington Veteran Affairs Medical Center and University of Kentucky Chandler Medical Center, Lexington, KY; Boston University School of Medicine, Boston, MA; National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD; Veteran Affairs Connecticut Healthcare System, West Haven, CT; Yale University School of Medicine, New Haven, CT.

4/2/10

Reference

MS Freiberg, KA McGinnis, K Kraemer, and others (VACS Project Team). The Association Between Alcohol Consumption and Prevalent Cardiovascular Diseases among HIV-Infected and HIV-Uninfected Men. Journal of Acquired Immune Deficiency Syndromes 53(2): 247-253 (Abstract). February 2010.