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Depression as a Risk Factor for Incident Ischemic Stroke Among HIV‐Positive Veterans in the Veterans Aging Cohort Study

BACKGROUND: HIV infection and depression are each associated with increased ischemic stroke risk. Whether depression is a risk factor for stroke within the HIV population is unknown. METHODS AND RESULTS: We analyzed data on 106 333 (33 528 HIV‐positive; 72 805 HIV‐negative) people who were free of b...

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Autores principales: Sico, Jason J., Kundu, Suman, So‐Armah, Kaku, Gupta, Samir K., Chang, Chung‐Chou H., Butt, Adeel A., Gibert, Cynthia L., Marconi, Vincent C., Crystal, Stephen, Tindle, Hilary A., Freiberg, Matthew S., Stewart, Jesse C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403311/
https://www.ncbi.nlm.nih.gov/pubmed/34169726
http://dx.doi.org/10.1161/JAHA.119.017637
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author Sico, Jason J.
Kundu, Suman
So‐Armah, Kaku
Gupta, Samir K.
Chang, Chung‐Chou H.
Butt, Adeel A.
Gibert, Cynthia L.
Marconi, Vincent C.
Crystal, Stephen
Tindle, Hilary A.
Freiberg, Matthew S.
Stewart, Jesse C.
author_facet Sico, Jason J.
Kundu, Suman
So‐Armah, Kaku
Gupta, Samir K.
Chang, Chung‐Chou H.
Butt, Adeel A.
Gibert, Cynthia L.
Marconi, Vincent C.
Crystal, Stephen
Tindle, Hilary A.
Freiberg, Matthew S.
Stewart, Jesse C.
author_sort Sico, Jason J.
collection PubMed
description BACKGROUND: HIV infection and depression are each associated with increased ischemic stroke risk. Whether depression is a risk factor for stroke within the HIV population is unknown. METHODS AND RESULTS: We analyzed data on 106 333 (33 528 HIV‐positive; 72 805 HIV‐negative) people who were free of baseline cardiovascular disease from an observational cohort of HIV‐positive people and matched uninfected veterans in care from April 1, 2003 through December 31, 2014. International Classification of Diseases, Ninth Revision (ICD‐9) codes from medical records were used to determine baseline depression and incident stroke. Depression occurred in 19.5% of HIV‐positive people. After a median of 9.2 years of follow‐up, stroke rates were highest among people with both HIV and depression and lowest among those with neither condition. In Cox proportional hazard models, depression was associated with an increased risk of stroke for HIV‐positive people after adjusting for sociodemographic characteristics and cerebrovascular risk factors (hazard ratio [HR], 1.18; 95% CI: 1.03–1.34; 0.014). The depression‐stroke relationship was attenuated by alcohol use disorders, cocaine use, and baseline antidepressant use, and unaffected by combined antiretroviral therapy use or individual antiretroviral agents. A numerically higher HR of depression on stroke was found among those younger than 60 years. CONCLUSIONS: Depression is associated with an increased risk of stroke among HIV‐positive people after adjusting for sociodemographic characteristics, traditional cerebrovascular risk factors, and HIV‐specific factors. Alcohol use disorders, cocaine use, and baseline antidepressant use accounted for some of the observed stroke risk. Depression may be a novel, independent risk factor for ischemic stroke in HIV, particularly among younger people.
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spelling pubmed-84033112021-09-03 Depression as a Risk Factor for Incident Ischemic Stroke Among HIV‐Positive Veterans in the Veterans Aging Cohort Study Sico, Jason J. Kundu, Suman So‐Armah, Kaku Gupta, Samir K. Chang, Chung‐Chou H. Butt, Adeel A. Gibert, Cynthia L. Marconi, Vincent C. Crystal, Stephen Tindle, Hilary A. Freiberg, Matthew S. Stewart, Jesse C. J Am Heart Assoc Original Research BACKGROUND: HIV infection and depression are each associated with increased ischemic stroke risk. Whether depression is a risk factor for stroke within the HIV population is unknown. METHODS AND RESULTS: We analyzed data on 106 333 (33 528 HIV‐positive; 72 805 HIV‐negative) people who were free of baseline cardiovascular disease from an observational cohort of HIV‐positive people and matched uninfected veterans in care from April 1, 2003 through December 31, 2014. International Classification of Diseases, Ninth Revision (ICD‐9) codes from medical records were used to determine baseline depression and incident stroke. Depression occurred in 19.5% of HIV‐positive people. After a median of 9.2 years of follow‐up, stroke rates were highest among people with both HIV and depression and lowest among those with neither condition. In Cox proportional hazard models, depression was associated with an increased risk of stroke for HIV‐positive people after adjusting for sociodemographic characteristics and cerebrovascular risk factors (hazard ratio [HR], 1.18; 95% CI: 1.03–1.34; 0.014). The depression‐stroke relationship was attenuated by alcohol use disorders, cocaine use, and baseline antidepressant use, and unaffected by combined antiretroviral therapy use or individual antiretroviral agents. A numerically higher HR of depression on stroke was found among those younger than 60 years. CONCLUSIONS: Depression is associated with an increased risk of stroke among HIV‐positive people after adjusting for sociodemographic characteristics, traditional cerebrovascular risk factors, and HIV‐specific factors. Alcohol use disorders, cocaine use, and baseline antidepressant use accounted for some of the observed stroke risk. Depression may be a novel, independent risk factor for ischemic stroke in HIV, particularly among younger people. John Wiley and Sons Inc. 2021-06-25 /pmc/articles/PMC8403311/ /pubmed/34169726 http://dx.doi.org/10.1161/JAHA.119.017637 Text en © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Sico, Jason J.
Kundu, Suman
So‐Armah, Kaku
Gupta, Samir K.
Chang, Chung‐Chou H.
Butt, Adeel A.
Gibert, Cynthia L.
Marconi, Vincent C.
Crystal, Stephen
Tindle, Hilary A.
Freiberg, Matthew S.
Stewart, Jesse C.
Depression as a Risk Factor for Incident Ischemic Stroke Among HIV‐Positive Veterans in the Veterans Aging Cohort Study
title Depression as a Risk Factor for Incident Ischemic Stroke Among HIV‐Positive Veterans in the Veterans Aging Cohort Study
title_full Depression as a Risk Factor for Incident Ischemic Stroke Among HIV‐Positive Veterans in the Veterans Aging Cohort Study
title_fullStr Depression as a Risk Factor for Incident Ischemic Stroke Among HIV‐Positive Veterans in the Veterans Aging Cohort Study
title_full_unstemmed Depression as a Risk Factor for Incident Ischemic Stroke Among HIV‐Positive Veterans in the Veterans Aging Cohort Study
title_short Depression as a Risk Factor for Incident Ischemic Stroke Among HIV‐Positive Veterans in the Veterans Aging Cohort Study
title_sort depression as a risk factor for incident ischemic stroke among hiv‐positive veterans in the veterans aging cohort study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403311/
https://www.ncbi.nlm.nih.gov/pubmed/34169726
http://dx.doi.org/10.1161/JAHA.119.017637
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