Women living with HIV who reported a high burden of psychosocial risk factors like symptoms of depression, stress and post-traumatic stress disorder (PTSD) were more likely to have prevalent subclinical atherosclerosis compared with those indicating a low burden, a study published in the Journal of the American Heart Association (JAHA) found.
Matthew E. Levy, PhD—of the department of epidemiology in the Milken Institute School of Public Health at The George Washington University, Washington, D.C.—et al further stated women with the virus who persistently reported high depressive symptoms over approximately equal to seven years had a greater risk of incident subclinical atherosclerosis compared with those who either rarely, never or sometimes reported high depressive symptoms.
People living with HIV have an elevated risk of subclinical atherosclerosis and cardiovascular disease, which is attributed in large part to chronic inflammation and immune activation, according to the research team. Additionally, women living with the virus have an almost equal to three times greater cardiovascular disease risk compared with HIV‐negative women. This suggests that the HIV‐associated cardiovascular disease risk is greater among women compared with men, they point out, though the cause is not well understood. Identification of novel pathways that can explain the excess risk among women living with HIV is needed, Levy et al write.
Which brings the team to the novel pathway of depression. “One potential [cardiovascular disease] pathway that remains understudied among [the group], despite women living with HIV and particularly [those] of color being disproportionately affected, is depressive symptoms and psychosocial risk,” the investigators elaborate.
Participants were women aged 25–60 years in the Women’s Interagency HIV Study—a multicenter prospective observational cohort study of women living with HIV and demographically similar HIV‐uninfected women at risk of infection—who had participated in a cardiovascular disease sub-study between 2004 and 2012. They were initially recruited and enrolled in 1994–1995 or 2001–2002 in Brooklyn and Bronx, New York; Chicago; Washington, D.C.; Los Angeles; and San Francisco.
During semi-annual visits, participants completed structured interviews and physical and laboratory assessments. Those with a known history of coronary heart disease were excluded from the current analysis so that the study sample would include participants currently at risk, the investigators said.
Right carotid artery ultrasounds were performed in 2004–2005, then again in 2010–2012. “We defined the presence of focal plaque as localized intima‐media thickness >1.5mm in at least one of six locations: the near and far walls of the common carotid artery, carotid bifurcation and proximal internal carotid artery,” the researchers explain. For cross‐sectional analyses, they defined prevalent focal plaque at the time of the final carotid ultrasound measurement in 2010–2012, excluding participants with a known history of coronary heart disease. Three psychosocial risk factors were defined using self‐reported data: high depressive symptoms, high perceived stress and probable PTSD.
Results show that among 700 women (median age 47 years), there were two classes of psychosocial risk—high (n=163) and low (n=537)—with corresponding prevalence of depression (65%/13%), high stress (96%/12%), and probable PTSD (46%/2%). Among women with HIV, plaque prevalence was 23% and 11% in high versus low psychosocial risk classes (adjusted odds ratio [aOR], 2.12; 95% CI, 1.11–4.05) compared with 9% and 9% among HIV‐negative women (aOR, 1.07; 95% CI, 0.24–4.84), respectively.
New plaque formation occurred among 17% and 9% of women living with HIV who reported high depressive symptoms at ≥45% versus <45% of visits (aOR, 1.96; 95% CI, 1.06–3.64), compared with 9% and 7% among HIV‐negative women (aOR, 0.82; 95% CI, 0.16–4.16), respectively.
Concluding, the researchers wrote: “This study demonstrates that psychosocial risk factors were independent risk factors for subclinical atherosclerosis among [women living with HIV]. Future research should further characterize differences by HIV status and sex in the risk of atherosclerosis, and of incident [cardiovascular disease] events, associated with a greater burden of psychosocial risk factors.
“Possible mechanisms by which psychosocial risk factors may differentially contribute to greater atherosclerotic risk among [women living with HIV] compared with HIV‐negative women should also be investigated.”
Furthermore, the investigators make the case that research is needed in order to determine whether clinical interventions for depression and psychosocial stress can mitigate the increased risk of subclinical atherosclerosis for female HIV patients.