Open AccessGender differences in the use of cardiovascular interventions in HIV ‐positive persons; the D:A:D Study
Author(s) -
Hatleberg Camilla I,
Ryom Lene,
ElSadr Wafaa,
Mocroft Amanda,
Reiss Peter,
De Wit Stephane,
Dabis Francois,
Pradier Christian,
d'Arminio Monforte Antonella,
Kovari Helen,
Law Matthew,
Lundgren Jens D,
Sabin Caroline A
Publication year - 2018
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25083
Subject(s) - medicine , psychological intervention , confounding , poisson regression , observational study , incidence (geometry) , proportional hazards model , hazard ratio , demography , confidence interval , population , environmental health , physics , psychiatry , sociology , optics
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 ( LLD s), angiotensin‐converting enzyme inhibitors ( ACEI s), anti‐hypertensives, invasive cardiovascular procedures ( ICP s) 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; LLD s: incidence rate 1.28 [1.21, 1.35] vs. 2.40 [2.34, 2.46]; ACEI s: 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 ICP s: 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 ( LLD s: relative rate 0.83 [0.78, 0.88]; ACEI s: 0.93 [0.86, 1.01]; ICP s: 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.