HIV-infected people often suffer from sleep disorders, which in turn increases the risk of a heart attack. An analysis of CNICS patient groups showed that patients with stressful insomnia in particular increase the risk of type 2 myocardial infarction. This was reported by Bridget M. Whitney, University of Washington, Seattle (USA), at the virtual CROI in March 2020.
HIV-infected people suffer more frequently from sleep disorders than the normal population. Insomnia is associated with a higher risk of cardiovascular disease and could play a role in the increased heart attack rate observed in HIV-infected individuals.
According to Whitney, there are two types of myocardial infarction (MI): type 1 MI, which is caused by the rupture of atherothrombotic plaque, and type 2 MI, which is caused by a disrupted supply due, for example, to sepsis or cocaine use. Type 2 MI appears to be more common in HIV-infected individuals.
This has been further investigated with the help of patient groups from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). From these groups, clinical data, patient-reported outcomes (PRO) and centrally assessed data on myocardial infarction with differentiation between type 1 and type 2 MI, are available. Whitney and her team used Cox models to investigate the association between insomnia and first myocardial infarction and MI type.
In 11,189 HIV-infected patients aged 43 years with an average follow-up time of 4.3 years, sleep disturbances were frequent with 57% (n = 6,405). Of these, 48% (n = 5,415) suffered from stressful insomnia. This means that in these cohorts a good half of the test subjects suffered from sleep disorders, which is consistent with the prevalence of 50% to 70% reported in the literature.
A total of 241 heart attacks occurred, of which 141 could be assigned to type 1 and 100 to type 2. Of the patients with stressful insomnia, 66 (47%) suffered a type 1 MI and 59 (59%) a type 2 MI.
In HIV patients with type 1 MI, no association with insomnia could be shown (hazard ratio 0.93), while the risk of type 2 MI was significantly increased with insomnia (hazard ratio 1.53, p = 0.04). Type 2 MIs are triggered by different factors, the most frequent cause in this cohort of 100 type 2 MIs was sepsis or bacteremia (35%), only 8% were due to cocaine or drug use.
These findings suggest that, especially in HIV-infected patients with heart attack, a distinction must be made as to whether type 1 or type 2 MI is present. The mechanism of this association must be clarified in further research.
Whitney BM, et al. Insomnia and risk of incident myocardial infarction among people living with HIV. Virtual CROI 2020, Abstract 644. http://www.croiconference.org/sessions/insomnia-and-risk-incident-myocardial-infarction-among-people-living-hiv