Cited by 20HIV-related health complications and treatmentsCardiovascular Health and Risk FactorsCardiac Health and Mental Health

Association of Syndemic Unhealthy Alcohol Use, Smoking, and Depressive Symptoms on Incident Cardiovascular Disease among Veterans With and Without HIV-Infection

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Chichetto, Natalie E., Kundu, Suman, Freiberg, Matthew S., Koethe, John R., Butt, Adeel A., Crystal, Stephen, So-Armah, Kaku A., Cook, Robert L. +12 more·2021·AIDS and Behavior

Abstract

Unhealthy alcohol use, smoking, and depressive symptoms are risk factors for cardiovascular disease (CVD). Little is known about their co-occurrence - termed a syndemic, defined as the synergistic effect of two or more conditions-on CVD risk in people with HIV (PWH). We used data from 5621 CVD-free participants (51% PWH) in the Veteran's Aging Cohort Study-8, a prospective, observational study of veterans followed from 2002 to 2014 to assess the association between this syndemic and incident CVD by HIV status. Diagnostic codes identified cases of CVD (acute myocardial infarction, stroke, heart failure, peripheral artery disease, and coronary revascularization). Validated measures of alcohol use, smoking, and depressive symptoms were used. Baseline number of syndemic conditions was categorized (0, 1, ≥ 2 conditions). Multivariable Cox Proportional Hazards regressions estimated risk of the syndemic (≥ 2 conditions) on incident CVD by HIV-status. There were 1149 cases of incident CVD (52% PWH) during the follow-up (median 10.1 years). Of the total sample, 64% met our syndemic definition. The syndemic was associated with greater risk for incident CVD among PWH (Hazard Ratio [HR] 1.87 [1.47-2.38], p < 0.001) and HIV-negative veterans (HR 1.70 [1.35-2.13], p < 0.001), compared to HIV-negative with zero conditions. Among those with the syndemic, CVD risk was not statistically significantly higher among PWH vs. HIV-negative (HR 1.10 [0.89, 1.37], p = .38). Given the high prevalence of this syndemic combined with excess risk of CVD, these findings support linked-screening and treatment efforts.

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  1. [48]Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The Alcohol Use Disorders Test. Guidelines for Use in Primary Care. Second ed. World Health Organization, Department of Mental Health and Substance Dependence.

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Authors
Chichetto, N. E., Kundu, S., Freiberg, M. S., Koethe, J. R., Butt, A. A., Crystal, S., So-Armah, K. A., Cook, R. L., Braithwaite, R. S., Justice, A. C., Fiellin, D. A., Khan, M., Bryant, K. J., Gaither, J. R., Barve, S. S., Crothers, K., Bedimo, R. J., Warner, A., Tindle, H. A., & Study, O. B. O. T. V. A. C.
Affiliations
  • Vanderbilt University Medical Center (US)
  • VA Tennessee Valley Healthcare System (US)
  • VA Pittsburgh Healthcare System (US)
  • Rutgers, The State University of New Jersey (US)
  • University of Florida Health (US)
  • New York University (US)
  • Yale University (US)
  • National Institute on Alcohol Abuse and Alcoholism (US)
  • University of Louisville (US)
  • University of Washington (US)
  • VA North Texas Health Care System (US)
  • University of California, Los Angeles (US)
Corresponding author
Chichetto, Natalie E.
Venue
AIDS and Behavior
Published
2021-06-08
Volume
25
Issue
9
Pages
2852-2862
ISSN
  • 1090-7165 (ISSN-L)
  • 1573-3254
OpenAlex
W3170641577
Cited by
20
References
110
Citations by year
2026: 5 · 2025: 3 · 2024: 7 · 2023: 4 · 2022: 1
FWCI
3.13
Type
journal article
Language
en
Open access
Locations
  • AIDS and Behavior (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Heart, Lung, and Blood Institute (K12HL143956)
  • National Institute on Alcohol Abuse and Alcoholism (U24AA020794, U01AA020790, U01AA02201, U10AA013566, K01AA029042)
Topics
  • Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
syndemic, cardiovascular disease, HIV infection, veterans, unhealthy alcohol use, smoking, depressive symptoms, incident cardiovascular disease, comorbidities, cardiovascular risk factors
MeSH terms
Syndemic, Cardiovascular Diseases, Depression, Humans, Prospective Studies, Risk Factors, Smoking, Veterans, Cohort Studies, HIV Infections, Incidence

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