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Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

Hatleberg, C.I., Ryom, L., El-Sadr, W., Mocroft, A., Reiss, P., De Wit, S., Dabis, F., Pradier, C., D'Arminio Monforte, A., Kovari, H., Law, M., Lundgren, J.D., Sabin, C.A. and Nolan, D. (2018) Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study. Journal of the International AIDS Society, 21 (3).

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Abstract

Introduction
There is paucity of data related to potential gender differences in the use of interventions to prevent and treat cardiovascular disease (CVD) among HIV‐positive individuals. We investigated whether such differences exist in the observational D:A:D cohort study.

Methods
Participants were followed from study enrolment until the earliest of death, six months after last visit or February 1, 2015. Initiation of CVD interventions [lipid‐lowering drugs (LLDs), angiotensin‐converting enzyme inhibitors (ACEIs), anti‐hypertensives, invasive cardiovascular procedures (ICPs) were investigated and Poisson regression models calculated whether rates were lower among women than men, adjusting for potential confounders.

Results
Women (n = 12,955) were generally at lower CVD risk than men (n = 36,094). Overall, initiation rates of CVD interventions were lower in women than men; LLDs: incidence rate 1.28 [1.21, 1.35] vs. 2.40 [2.34, 2.46]; ACEIs: 0.88 [0.82, 0.93] vs. 1.43 [1.39, 1.48]; anti‐hypertensives: 1.40 [1.33, 1.47] vs. 1.72 [1.68, 1.77] and ICPs: 0.08 [0.06, 0.10] vs. 0.30 [0.28, 0.32], and this was also true for most CVD interventions when exclusively considering periods of follow‐up for which individuals were at high CVD risk. In fully adjusted models, women were less likely to receive CVD interventions than men (LLDs: relative rate 0.83 [0.78, 0.88]; ACEIs: 0.93 [0.86, 1.01]; ICPs: 0.54 [0.43, 0.68]), except for the receipt of anti‐hypertensives (1.17 [1.10, 1.25]).

Conclusion
The use of most CVD interventions was lower among women than men. Interventions are needed to ensure that all HIV‐positive persons, particularly women, are appropriately monitored for CVD and, if required, receive appropriate CVD interventions.

Item Type: Journal Article
Murdoch Affiliation: Institute for Immunology and Infectious Diseases
Publisher: John Wiley & sons Ltd on behalf of the International AIDS Society.
Copyright: © 2018 The Authors.
Other Information: David Nolan appears courtesy of the D.A.D Study Group
URI: http://researchrepository.murdoch.edu.au/id/eprint/41467
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