Isn’t Alcohol Good for My Heart? Alcohol and Cardiovascular Risk in HIV-Infected and Uninfected Men

Current data suggest that unhealthy alcohol use increases cardiovascular disease (CVD) risk and mortality. Although these associations have been repeatedly demonstrated in adults without HIV infection, they have yet to be elucidated in HIV-infected patients, among whom both HIV disease progression and antiretroviral therapy (ART) have been linked with CVD. In this study, researchers sought to determine the association between alcohol consumption and CVD among HIV-infected men by examining cross-sectional data from 4743 participants in the Veterans Aging Cohort Study, a prospective study of HIV-infected men and race-, age-, and site-matched uninfected controls. Fifty-one percent of the sample had HIV infection. Results were adjusted for demographics, traditional cardiovascular risk factors, liver or kidney disease, hepatitis-C infection, cocaine use, exercise, adherence to ART, and CD4 count.

• Cardiovascular disease was common among HIV-infected and uninfected men (15% and 20%, respectively) as were hazardous drinking* (33% and 31%) and alcohol abuse and dependence (21% and 26%).

• Hazardous drinking, compared with moderate drinking, was associated with a higher prevalence of CVD (odds ratio [OR], 1.43) and alcohol abuse or dependence (OR, 1.55) among HIV-infected men.

• An interaction was noted between HIV status and alcohol consumption (p=0.001), suggesting that the association between unhealthy alcohol use and CVD was more pronounced among HIV-infected men compared with uninfected men.

Comments:

These results suggest that, compared with moderate use, unhealthy alcohol use is associated with a higher prevalence of CVD in HIV-infected individuals, and this association may be more pronounced in people with HIV infection than in those without. However, certain methodologic limitations are noted. Cross-sectional studies do not allow an assessment of causality and, in this study, exposure to antiretroviral medication is self-reported and lacking information on cumulative and type of exposure. This is important, since antiretroviral medication has been associated with the development of traditional CVD risk factors (e.g., glucose intolerance and hyperlipidemia). Future longitudinal studies should investigate incident CVD events in HIV-infected individuals with unhealthy alcohol use, paying particular attention to antiretroviral treatment history.

Jeanette M. Tetrault, MD

Reference:

Freiberg MS, McGinnis KA, Kraemer K, et al. The association between alcohol consumption and prevalent cardiovascular diseases among HIV-infected and HIV-uninfected men. J Acquir Immune Defic Syndr. 2010;53(2): 247–53.