Cardiac and Vascular Diseases in Patients with HIV with Review of the National Inpatient Sample Database from 2015 to 2020

Abstract

Background: As people living with HIV (PLWH) experience increased life expectancy due to widespread use of antiretroviral therapy (ART), the burden of non-communicable diseases—especially cardiovascular diseases (CVDs)—has grown significantly. Emerging data suggests that PLWH are at higher risk for adverse cardiac and vascular events compared to the general population, even when virologically suppressed.
Objective: To assess the prevalence, trends, and predictors of major adverse cardiovascular events (MACE) among hospitalized HIV-positive adults in the United States using data from the National Inpatient Sample (2015–2020).
Methods: This retrospective observational study analyzed over 1.1 million hospitalizations of HIV-positive individuals aged >18 years. The primary outcome was MACE, defined as a composite of heart failure (HF), myocardial infarction (MI), and cerebrovascular accident (CVA). Secondary outcomes included length of hospital stay (LOS), in-hospital mortality, and demographic and clinical predictors of MACE. Multivariable logistic regression models were applied to determine independent predictors.
Results:
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PLWH accounted for 6.2% of all adult hospitalizations during the study period and were significantly younger (mean age: 49.9 vs. 57.9 years, p<0.001) and more likely to be Black (52.1%) or low-income (49.8%) compared to non-HIV individuals.
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The overall MACE prevalence among PLWH was 22.6%, with a statistically significant upward trend from 2016 to 2020 (p<0.001).
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Independent predictors of MACE included older age, hypertension, dyslipidemia, atrial fibrillation, chronic kidney disease, end-stage renal disease, and obesity.
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Mortality was disproportionately higher among racial and ethnic minorities (Black, Hispanic, Asian, and Native American patients), individuals on Medicaid or self-pay insurance, and those with MI, stroke, or ESRD.
Conclusions: PLWH face a markedly elevated burden of cardiovascular comorbidities and adverse outcomes, driven by both traditional risk factors and HIV-specific mechanisms. MACE prevalence is rising, underscoring the need for tailored cardiovascular risk mitigation strategies in HIV care. Sociodemographic disparities further compound clinical outcomes, highlighting the urgency for equitable health interventions.