Abstract
Background Depression and anxiety have been associated with increased risk of myocardial infarction (MI) in the general population and among people with HIV (PWH) but with limited attention to MI type. We examined the association between depression and/or anxiety and incident Type 1 (T1MI) or Type 2 (T2MI) MI among PWH. Methods We examined data from seven NA-ACCORD clinical cohorts (1997-2019) with adjudicated first MI; outcomes included T1MI (plaque rupture or cardiac intervention) or T2MI (demand ischemia). We defined depression or anxiety as a time-varying ICD-9/10-coded diagnosis prior to incident MI. We censored participants at death, disengagement from care, or first MI (if not the outcome of interest). We used Cox proportional hazard models to estimate the association between depression or anxiety and MI by type, adjusting for demographics and risk factors for MI. Results Of the 32,358 study participants, 13,751 (42.5%) had a depression diagnosis, 9,132 (28.2%) had an anxiety diagnosis, and 15,970 (47.3%) never had diagnosed depression or anxiety. After adjusting for MI risk factors, depression was associated with T1MI (aHR, 1.22 [95% CI, 1.00-1.48]) and anxiety had a protective association (albeit not statistically significant) with T1MI (aHR, 0.86 [95% CI, 0.70-1.07]). Depression had a null association (aHR, 1.05 [95% CI, 0.83-1.33] with T2MI, and anxiety was non-significantly associated with T2MI (aHR, 1.16 [95% CI, 0.89-1.51]). Conclusions Diagnosed depression was associated with T1MI but not T2MI, whereas anxiety was not statistically significantly associated with either MI type. Mental health diagnosis and treatment may play an important role in cardiovascular health among PWH.