Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study. Journal of the International AIDS Society
Hatleberg et al. on behalf of the D:A:D study group aimed to investigate potential gender differences in the use of cardiovascular interventions in HIV-positive persons. Cardiovascular disease (CVD) interventions included lipid-lowering drugs (LLDs), angiotensin-converting enzyme inhibitors (ACEIs), anti-hypertensives, and invasive cardiovascular procedures (ICPs).
Women (n = 12’955) were generally at lower CVD risk than men (n = 36,094). Overall, initiation rates of CVD interventions were lower in women than men; LLDs: incidence rate 1.28 vs. 2.40; ACEIs: 0.88 vs. 1.43; anti-hypertensives: 1.40 vs. 1.72 and ICPs: 0.08 vs. 0.30. This was also true for most CVD interventions when exclusively considering periods of follow-up for which individuals were at high CVD risk. In fully adjusted models, women were less likely to receive CVD interventions than men (LLDs: relative rate 0.83; ACEIs: 0.93; ICPs: 0.54) except for the receipt of anti-hypertensives (1.17).
In conclusion, the study shows that HIV-positive women were less likely than men to receive most CVD-related interventions, with the exception of anti-hypertensive drugs. These findings are mostly consistent with those from the general population. The reasons why women are less likely to receive interventions than men are multiple, but insufficient monitoring and awareness of CVD risk in women, and the more heterogeneous clinical presentations of CVD probably play a major role. As HIV-positive individuals in general are potentially at higher risk of CVD, further efforts are needed to ensure that both women and men are appropriately monitored for CVD risk and, if required, receive relevant CVD-related interventions. Furthermore, studies are warranted on why these gender related differences exist in the prevention and management of CVD in HIV-positive individuals.