Influence of substance use on cardiovascular risk factors and disease among HIV-positive clinic patients in NYC: Findings from electronic medical record data

Background: Cardiovascular disease (CVD) contributes to morbidity and mortality among HIV-positive persons. While a link between substance use and increased morbidity and mortality has been established, little is known about the impact of alcohol and drug-use (ADU) problems on CVD risk among HIV-positive persons.

Methods: Analyses were based on electronic medical records (EMRs) of 5,584 HIV-positive patients in NYC to examine the link between ADU problems using ICD-9/10 diagnoses of abuse/dependence and CVD risk factors by comparing four groups: no ADU problems (71.1%), alcohol only (3.8%), drug only (16.9%), and both ADU problems (8.2%).

Results: Most of the patients (79%) were men, 75% identified as Black or Latino, and the mean age was 46 years. Time since HIV diagnosis was 13 years on average, and 4% of patients had a CVD diagnosis. A significant number of both ADU and drug only patients had a documented CVD event (5.7% and 5.2%, respectively) compared to the no ADU problems and alcohol only groups (2.8% and 3.3%, respectively; p<.001). A significant number of patients with ADU problems also had detectable viral loads, AIDS diagnosis, hypertension, and smoked compared to the other groups (p<.001). After controlling for age, race, gender, time since HIV diagnosis, AIDS diagnosis, and viral load, the number of risk factors was greatest for the ADU group (Wald Chi-square=117.88, p<.001).

Conclusions: HIV-positive patients with ADU problems are at increased risk for CVD. Integrating substance use treatment into HIV care is critical to reduce CVD risk for a substantial number of people.