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Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

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Abstract
Introduction: There is paucity of data related to potential gender differences in the use of interventions to prevent and treat cardiovascular disease (CVD) among HIV-positive individuals. We investigated whether such differences exist in the observational D:A:D cohort study. Methods: Participants were followed from study enrolment until the earliest of death, six months after last visit or February 1, 2015. Initiation of CVD interventions [lipid-lowering drugs (LLDs), angiotensin-converting enzyme inhibitors (ACEIs), anti-hypertensives, invasive cardiovascular procedures (ICPs) were investigated and Poisson regression models calculated whether rates were lower among women than men, adjusting for potential confounders. Results: 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 [1.21, 1.35] vs. 2.40 [2.34, 2.46]; ACEIs: 0.88 [0.82, 0.93] vs. 1.43 [1.39, 1.48]; anti-hypertensives: 1.40 [1.33, 1.47] vs. 1.72 [1.68, 1.77] and ICPs: 0.08 [0.06, 0.10] vs. 0.30 [0.28, 0.32], and 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 [0.78, 0.88]; ACEIs: 0.93 [0.86, 1.01]; ICPs: 0.54 [0.43, 0.68]), except for the receipt of anti-hypertensives (1.17 [1.10, 1.25]). Conclusion: The use of most CVD interventions was lower among women than men. Interventions are needed to ensure that all HIV-positive persons, particularly women, are appropriately monitored for CVD and, if required, receive appropriate CVD interventions.
Keywords
ACUTE MYOCARDIAL-INFARCTION, ACUTE CORONARY SYNDROME, IN-HOSPITAL, MORTALITY, SEX-DIFFERENCES, HEART-DISEASE, RISK-FACTORS, SYMPTOM, PRESENTATION, CLINICAL PRESENTATION, GENERAL-POPULATION, INFECTED, PATIENTS, Cardiovascular disease, gender, cardiovascular disease interventions, cohort studies, HIV, women, myocardial infarction, stroke

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MLA
Hatleberg, Camilla I., et al. “Gender Differences in the Use of Cardiovascular Interventions in HIV-Positive Persons; the D:A:D Study.” JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, vol. 21, no. 3, 2018.
APA
Hatleberg, C. I., Ryom, L., El-Sadr, W., Mocroft, A., Reiss, P., De Wit, S., … Vandekerckhove, L. (2018). Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study. JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, 21(3).
Chicago author-date
Hatleberg, Camilla I, Lene Ryom, Wafaa El-Sadr, Amanda Mocroft, Peter Reiss, Stephane De Wit, Francois Dabis, et al. 2018. “Gender Differences in the Use of Cardiovascular Interventions in HIV-Positive Persons; the D:A:D Study.” JOURNAL OF THE INTERNATIONAL AIDS SOCIETY 21 (3).
Chicago author-date (all authors)
Hatleberg, Camilla I, Lene Ryom, Wafaa El-Sadr, Amanda Mocroft, Peter Reiss, Stephane De Wit, Francois Dabis, Christian Pradier, Antonella d’Arminio Monforte, Helen Kovari, Matthew Law, Jens D Lundgren, Caroline A Sabin, on behalf of the Data Collection of Adverse Events of Anti-HIV drugs (D:A:D) Study group, and Linos Vandekerckhove. 2018. “Gender Differences in the Use of Cardiovascular Interventions in HIV-Positive Persons; the D:A:D Study.” JOURNAL OF THE INTERNATIONAL AIDS SOCIETY 21 (3).
Vancouver
1.
Hatleberg CI, Ryom L, El-Sadr W, Mocroft A, Reiss P, De Wit S, et al. Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study. JOURNAL OF THE INTERNATIONAL AIDS SOCIETY. 2018;21(3).
IEEE
[1]
C. I. Hatleberg et al., “Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study,” JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, vol. 21, no. 3, 2018.
@article{8632928,
  abstract     = {Introduction: There is paucity of data related to potential gender differences in the use of interventions to prevent and treat cardiovascular disease (CVD) among HIV-positive individuals. We investigated whether such differences exist in the observational D:A:D cohort study. 
Methods: Participants were followed from study enrolment until the earliest of death, six months after last visit or February 1, 2015. Initiation of CVD interventions [lipid-lowering drugs (LLDs), angiotensin-converting enzyme inhibitors (ACEIs), anti-hypertensives, invasive cardiovascular procedures (ICPs) were investigated and Poisson regression models calculated whether rates were lower among women than men, adjusting for potential confounders. 
Results: 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 [1.21, 1.35] vs. 2.40 [2.34, 2.46]; ACEIs: 0.88 [0.82, 0.93] vs. 1.43 [1.39, 1.48]; anti-hypertensives: 1.40 [1.33, 1.47] vs. 1.72 [1.68, 1.77] and ICPs: 0.08 [0.06, 0.10] vs. 0.30 [0.28, 0.32], and 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 [0.78, 0.88]; ACEIs: 0.93 [0.86, 1.01]; ICPs: 0.54 [0.43, 0.68]), except for the receipt of anti-hypertensives (1.17 [1.10, 1.25]). 
Conclusion: The use of most CVD interventions was lower among women than men. Interventions are needed to ensure that all HIV-positive persons, particularly women, are appropriately monitored for CVD and, if required, receive appropriate CVD interventions.},
  articleno    = {e25083},
  author       = {Hatleberg, Camilla I and Ryom, Lene and El-Sadr, Wafaa and Mocroft, Amanda and Reiss, Peter and De Wit, Stephane and Dabis, Francois and Pradier, Christian and Monforte, Antonella d'Arminio and Kovari, Helen and Law, Matthew and Lundgren, Jens D and Sabin, Caroline A and Data Collection of Adverse Events of Anti-HIV drugs (D:A:D) Study group, on behalf of the and Vandekerckhove, Linos},
  issn         = {1758-2652},
  journal      = {JOURNAL OF THE INTERNATIONAL AIDS SOCIETY},
  keywords     = {ACUTE MYOCARDIAL-INFARCTION,ACUTE CORONARY SYNDROME,IN-HOSPITAL,MORTALITY,SEX-DIFFERENCES,HEART-DISEASE,RISK-FACTORS,SYMPTOM,PRESENTATION,CLINICAL PRESENTATION,GENERAL-POPULATION,INFECTED,PATIENTS,Cardiovascular disease,gender,cardiovascular disease interventions,cohort studies,HIV,women,myocardial infarction,stroke},
  language     = {eng},
  number       = {3},
  pages        = {13},
  title        = {Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study},
  url          = {http://dx.doi.org/10.1002/jia2.25083},
  volume       = {21},
  year         = {2018},
}

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