Cardiovascular Disease Risk and Falls in Men and Women Living With and Without HIV in MACS/WIHS Combined Cohort Study

BACKGROUND: We examined the cross-sectional relationship between cardiovascular disease (CVD) risk, history of falls, and the number of falls in the past year in the US multicenter MACS/WIHS Combined Cohort Study (2020-2022) of men and women without HIV (MWOH/WWOH) and men and women with HIV (MWH/WWH). SETTING/METHODS: CVD risk was assessed by pooled cohort equation 10-year risk scores and categorized into 4 levels. Self-reported falls outcomes (recent fall, not recent fall, one fall, multiple falls) were assessed using a standardized protocol. Odds ratios of falls were measured using multinomial regression models stratified by sex and adjusted for ethnicity, education attainment, alcohol consumption, body-mass index, fall-risk medications, physical activity, and HIV serostatus. RESULTS: There were 2723 participants, 35% were men (577 MWH, 360 MWOH) with a median age of 58 (IQR: 14) years. Women represented 65% (1271 WWH, 515 WWOH) with a median age of 55 (IQR: 11) years. In sex stratified multinomial adjusted models, among men, high CVD risk (vs. low risk) was significantly associated with a recent fall (vs. never fall) (aOR: 3.12, 95% CI: 1.59 to 6.13) and one fall (vs. no fall) in past year (aOR: 3.66; 95% CI: 1.45 to 9.21). Among women, high CVD risk was only significantly associated with multiple falls (vs. no fall) in past year (aOR: 2.06; 95% CI: 1.24 to 3.43). CONCLUSION: Our findings highlight the importance of integrating fall-risk assessments into CVD management, particularly for men and women with living with HIV and high CVD risk, and the need for targeted, gender-responsive fall prevention strategies in clinical practice.