Types of myocardial infarction in people with HIV in Switzerland
Cardiovascular disease is an important comorbidity in people with HIV. Myocardial infarction (MI) can occur as Type 1 due to atherosclerotic plaque rupture, or Type 2 due to an imbalance in oxygen supply and demand. In the US, up to 50% of MI in people with HIV have been reported to be Type 2 MI, which is substantially higher compared to the general population. As data on the distribution of MI types in European PWH is missing, Kleynhans, Cobo, and Avery et al. performed a study investigating MI events in the Swiss HIV Cohort Study (SHCS) to differentiate between Type 1 and Type 2, and clarify their frequency, trends, and potential genetic and inflammatory risk factors.
Between 2000 and 2021, the SHCS recorded 379 first MI events during 181’598 person-years of follow-up. Of these, 359 (95%) were Type 1 MIs and 20 (5%) were Type 2 MIs. Coronary angiography was performed in nearly all Type 1 MI cases (95%), but less frequently in Type 2 MIs (60%). The incidence of both MI types remained stable over time. Higher leukocyte counts and genetic risk scores for coronary artery disease were associated with increased odds of Type 1 MIs, while limited case numbers prevented firm conclusions for Type 2 MI.
In summary, only 5% of MIs in the SHCS were of Type 2, which is much lower than proportions reported from North America and aligning closer to the general Swiss population. These results underline the importance of traditional atherosclerotic cardiovascular mechanisms and host genetic predisposition in the pathogenesis of MI among people with HIV.