Depression found to be a risk factor for incident ischemic stroke among HIV‐Positive veterans

1. Depression was associated with elevated risk for ischemic stroke in veterans living with HIV, particularly in those under 60 years of age.

2. Factors that contributed to this association included alcohol use disorders, cocaine use, and antidepressant use.

Evidence Rating Level: 3 (Average)

Patients with HIV tend to have fewer of the common risk factors for ischemic stroke and other cerebrovascular events, such as hypertension or Type 2 Diabetes, meaning that there may be other important factors that increase stroke risk in the HIV population. For example, depression has been shown to be associated with stroke risk, and depression is also strongly associated with HIV status. The current study examined whether clinically diagnosed depression was a factor for increased stroke risk in the HIV population, and specifically in a cohort of veterans living with HIV. The study population consisted of patients 106,333 patients from the Veterans Aging Cohort Study, with 1 HIV-positive veteran matched to 2 HIV-negative veterans (33,528 HIV-positive and 72,805 HIV-negative veterans). Median follow-up was 9.2 years (interquartile range 5.2-11.5 years). Overall, the prevalence of depression was similar between HIV-positive and negative individuals (19.5% and 18.8% respectively). Upon adjusting for sociodemographic factors, there was a 22% greater risk of stroke in HIV-positive veterans with depression than without depression (hazards ratio 1.22, 95% CI 1.07-1.38, p = 0.003). This association persisted after adjusting for As age increases, this association declines, and is no longer statistically significant for patients 60 years and older. Furthermore, the association was not significant after controlling for antidepressant use (HR 1.16, 95% CI 1.00-1.36, p = 0.055), as well as alcohol use disorders and cocaine use. In conclusion, there is an elevated risk for ischemic stroke associated with depression in the HIV-positive veteran population, especially for individuals under the age of 60.

Click to read the study in JAHA

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