Syndemic burden, menopause, and cardiovascular risk among midlife and older women with and without HIV
- 1University of Miami Miller School of Medicine
Abstract
Midlife and older women living with HIV often carry several co-occurring social and behavioral stressors, and how that accumulated burden relates to cardiovascular risk is not well described. We examined whether cumulative syndemic burden was associated with estimated 10-year risk of atherosclerotic cardiovascular disease among women aged 45 years and older, and whether menopause stage modified it. Data came from the MACS/WIHS Combined Cohort Study, a multisite United States cohort, for visits between October 2020 and March 2025. The full sample included 1,993 women, 1,446 of them living with HIV; a secondary sample of 1,063 women virally suppressed at baseline contributed 4,009 visits. Syndemic burden was the sum of six conditions: elevated depressive symptoms, current tobacco use, hazardous alcohol use, recent stimulant use, physical inactivity, and material insecurity. Ten-year cardiovascular risk was estimated with the Pooled Cohort Equations and modeled with linear mixed-effects models with random intercepts; random forest classifiers were trained separately to predict high estimated risk (7.5 percent or greater). Median age was 56 years, 63 percent were non-Hispanic Black, and 57 percent reported two or more syndemic conditions. Each additional syndemic condition was associated with a 0.40-point higher estimated risk score (95 percent confidence interval 0.01 to 0.78; p=0.043), and postmenopausal status with a 1.3-point higher score than premenopause (0.39 to 2.3; p=0.006). The syndemic burden by menopause stage interaction was not significant overall (p=0.2), although an exploratory signal was present among virally suppressed women (0.50; p=0.079). The classifiers discriminated moderately (areas under the curve 0.727 and 0.704); serum creatinine, body mass index, syndemic burden, and postmenopausal status ranked among the most important predictors. Syndemic burden and reproductive aging were each independently and modestly associated with higher estimated cardiovascular risk, supporting joint assessment of both in risk stratification for midlife women with and without HIV.
Related
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BibTeX
@misc{pan2026syndemic,
title = {{Syndemic burden, menopause, and cardiovascular risk among midlife and older women with and without HIV}},
author = {Y. Pan and E. M. Cherenack and D. J. Feaster and Y. Lu and B. Young and K. V. McNeely and T. Wilson and B. A. Peters and E. B. Levitan and C. Moran and C. Ramirez and E. F. Topper and K. Weber and R. Abelman and A. B. Spence and C. A. Sternberg and N. Fonseca Nogueira and C. A. Martinez and M. L. Alcaide and D. L. Jones},
howpublished = {medRxiv},
year = {2026},
month = nov,
doi = {10.64898/2026.11.03.26367225},
url = {https://www.medrxiv.org/content/10.64898/2026.11.03.26367225v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Syndemic burden, menopause, and cardiovascular risk among midlife and older women with and without HIV
AU - Y. Pan
AU - E. M. Cherenack
AU - D. J. Feaster
AU - Y. Lu
AU - B. Young
AU - K. V. McNeely
AU - T. Wilson
AU - B. A. Peters
AU - E. B. Levitan
AU - C. Moran
AU - C. Ramirez
AU - E. F. Topper
AU - K. Weber
AU - R. Abelman
AU - A. B. Spence
AU - C. A. Sternberg
AU - N. Fonseca Nogueira
AU - C. A. Martinez
AU - M. L. Alcaide
AU - D. L. Jones
PY - 2026
DA - 2026/11/03
PB - medRxiv
DO - 10.64898/2026.11.03.26367225
UR - https://www.medrxiv.org/content/10.64898/2026.11.03.26367225v1
AB - Midlife and older women living with HIV often carry several co-occurring social and behavioral stressors, and how that accumulated burden relates to cardiovascular risk is not well described. We examined whether cumulative syndemic burden was associated with estimated 10-year risk of atherosclerotic cardiovascular disease among women aged 45 years and older, and whether menopause stage modified it. Data came from the MACS/WIHS Combined Cohort Study, a multisite United States cohort, for visits between October 2020 and March 2025. The full sample included 1,993 women, 1,446 of them living with HIV; a secondary sample of 1,063 women virally suppressed at baseline contributed 4,009 visits. Syndemic burden was the sum of six conditions: elevated depressive symptoms, current tobacco use, hazardous alcohol use, recent stimulant use, physical inactivity, and material insecurity. Ten-year cardiovascular risk was estimated with the Pooled Cohort Equations and modeled with linear mixed-effects models with random intercepts; random forest classifiers were trained separately to predict high estimated risk (7.5 percent or greater). Median age was 56 years, 63 percent were non-Hispanic Black, and 57 percent reported two or more syndemic conditions. Each additional syndemic condition was associated with a 0.40-point higher estimated risk score (95 percent confidence interval 0.01 to 0.78; p=0.043), and postmenopausal status with a 1.3-point higher score than premenopause (0.39 to 2.3; p=0.006). The syndemic burden by menopause stage interaction was not significant overall (p=0.2), although an exploratory signal was present among virally suppressed women (0.50; p=0.079). The classifiers discriminated moderately (areas under the curve 0.727 and 0.704); serum creatinine, body mass index, syndemic burden, and postmenopausal status ranked among the most important predictors. Syndemic burden and reproductive aging were each independently and modestly associated with higher estimated cardiovascular risk, supporting joint assessment of both in risk stratification for midlife women with and without HIV.
ER -