Rates of cardiovascular disease following smoking cessation in patients with HIV infection: results from the D:A:D study(*)

Objectives

The aim of the study was to estimate the rates of cardiovascular disease (CVD) events after stopping smoking in patients with HIV infection.

Methods

Patients who reported smoking status and no previous CVD prior to enrolment in the Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) study were included in this study. Smoking status is collected at each visit as current smoker (yes/no) and ever smoker (yes/no). Time since stopping smoking was calculated for persons who had reported current smoking during follow‐up and no current smoking subsequently. Endpoints were: myocardial infarction (MI); coronary heart disease (CHD: MI plus invasive coronary artery procedure or death from other CHD); CVD (CHD plus carotid artery endarterectomy or stroke); and all‐cause mortality. Event rates were calculated for never, previous and current smokers, and smokers who stopped during follow‐up. Incidence rate ratios (IRRs) were determined using Poisson regression adjusted for age, sex, cohort, calendar year, family history of CVD, diabetes, lipids, blood pressure and antiretroviral treatment.

Results

A total of 27 136 patients had smoking status reported, with totals of 432, 600, 746 and 1902 MI, CHD, CVD and mortality events, respectively. The adjusted IRR of CVD in patients who stopped smoking during follow‐up decreased from 2.32 within the first year of stopping to 1.49 after >3 years compared with those who never smoked. Similar trends were observed for the MI and CHD endpoints. Reductions in risk were less pronounced for all‐cause mortality.

Conclusion

The risk of CVD events in HIV‐positive patients decreased with increasing time since stopping smoking. Smoking cessation efforts should be a priority in the management of HIV‐positive patients.