Heavy drinking increases cardiovascular disease risk for men with HIV

Heavy drinking increases the risk of cardiovascular disease for men with HIV, US investigators report in an article published in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

“Hazardous drinking and alcohol abuse or dependence were significantly associated with an increased prevalence of cardiovascular disease as compared with infrequent or moderate drinkers”, comment the investigators.

They emphasise that the association between heavy drinking and cardiovascular disease was still present when they took into account both traditional risk factors for such illnesses and the patients’ HIV-related characteristics.

It is possible that alcohol is related to a number of health problems in people with HIV. These include poor adherence to antiretroviral treatment, liver disease, HIV disease progression, and an increased risk of cardiovascular disease.

The association between heavy drinking, or alcohol abuse and dependency, and illnesses such as heart disease and stroke in HIV-negative individuals is well understood.

However, less is known about this relationship in patients with HIV.

US investigators therefore designed a study involving 4743 US male veterans. Just over half the patients (2422, 51%) were HIV-positive. Information on alcohol use was obtained, as were data on traditional risk factors for cardiovascular disease.

The investigators defined hazardous drinking as the consumption of more than 14 alcoholic drinks in one week, and binge drinking as the consumption of six drinks in a single session more than once a month.

Hazardous drinking or alcohol abuse and dependence as common in both HIV-positive and HIV-negative individuals.

There was a higher prevalence of several traditional risk factors for cardiovascular disease amongst HIV-negative patients than amongst those with HIV. These included high cholesterol, diabetes, high blood pressure and body mass index (all p < 0.001). In contrast, individuals with HIV were more likely to smoke, be infected with hepatitis C virus, and have liver disease (all p < 0.001).

Hazardous drinking (odds ratio [OR], 1.35; 95% CI, 1.01-1.79) or alcohol dependency OR = 1.51; 95% CI, 1.09-2.09) were associated with an increased risk of cardiovascular disease for HIV-positive, but not HIV-negative men.

For both HIV-positive and HIV-negative men, traditional risk factors such as age, cholesterol, high blood pressure, and smoking were also significantly associated with an elevation in the risk of cardiovascular disease.

Further statistical analyses was then performed including only the patients with HIV and controlling for traditional risk factors for cardiovascular disease.

These showed that hazardous drinking was significantly associated with heart failure (OR = 1.74; 95% CI, 1.04-2.91), that alcohol dependency was related to heart disease (OR = 1.76; 95% CI, 1.06-2.64), and that past alcohol consumption (defined as one or more drink ever), increased the risk of stroke (OR = 1.78; 95% CI, 1.24-2.54).

Binge drinking was also shown to increase the risk of cardiovascular disease for those with HIV (OR = 1.30; 95% CI, 1.02-1.66).

“In the present study, among HIV-infected veterans, there was a significant increase in the prevalence of cardiovascular disease for hazardous drinking and alcohol abuse”, write the investigators. They suggest that this could partly be explained by the increases in lipids associated with heavy drinking. However, they also note that previous research in this cohort of patients “also demonstrated a temporal and dose-response relationship between alcohol consumption and medication adherence.”

“The effect of alcohol may be more pronounced among those infected with HIV”, conclude the investigators.