HIV and Heart Attacks

Research published today has offered new insight into the little understood relationship between HIV and cardiovascular disease, and shown that people with HIV may have a greater risk of heart attacks.

Doctors have long known that people with HIV tend to be at greater risk for the narrowing or hardening of the arteries, also known as atherosclerosis. The problem is compounded by interactions that occur between traditional HIV medications and some of the statin drugs that are used to treat high cholesterol.

Atherosclerosis occurs naturally as we age. This presents an even greater challenge for doctors, as people with HIV can now live well into their golden years.

Dr. Wendy Post and her colleagues at Johns Hopkins University School of Medicine have discovered important clues about the plaque that forms in the arteries of those living with HIV. Their findings, published in the Annals of Internal Medicine, reveal that a majority of the plaque in the arteries of people with HIV is “soft,” or non-calcified. It is this type of plaque that tends to cause heart attacks.

The researchers used a relatively new diagnostic tool known as a coronary CT angiogram. This type of scan offers a better look at plaque buildup than older imaging techniques.

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Study participants came from the well-known Multicenter AIDS Cohort Study (MACS). Post's group studied almost 1,000 gay and bisexual men between the ages of 40 and 70, both HIV-positive and HIV-negative. She believes the study was made more accurate by its study population being made up of gay and bisexual men, who may share common environmental and lifestyle factors.

The Risks and Benefits of HAART

Researchers say that people with HIV tend to have more traditional risk factors for heart problems, such as smoking, diabetes, low levels of “good” (high-density lipoprotein, or HDL) cholesterol, and high triglycerides. But Post statistically controlled for these factors.

Highly active antiretroviral therapy, or HAART, can also cause metabolic side effects, such as abnormal cholesterol levels and diabetes. Post's study showed that people who had been on these medications the longest tended to have more plaque buildup.

But higher levels of plaque buildup also corresponded with low “rock-bottom” or nadir CD-4 T-cell counts. White blood cells called CD-4 cells also are known as “helper” cells and can be a measure of how powerfully the HIV virus has attacked a person's immune system.

She said her study may suggest that people need to begin HAART treatment sooner, but further studies are needed to explore that, she said.

Make Sure You 'Know Your Numbers'

Post told Healthline that her work emphasizes that people with HIV need to to take care of their hearts and be aware of cardiovascular risks.

“They should 'know their numbers,' which means they should know their cholesterol, blood pressure, diabetes status, body mass index, and their calculated risk for future heart attack or stroke from established risk equations,” she said, recommending the American Heart Association's website for guidelines as well as heart attack warning signs to watch out for.

“Most importantly, if they currently smoke, they should discuss potential therapies to help with smoking cessation with their health care provider,” Post added.

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Dr. Merle Myerson, director of cardiovascular disease prevention at Mount Sinai St. Luke's Hospital in New York, called Post's research important, even though it confirms long-held beliefs.

There are many medications on the market to treat cardiovascular disease, she told Healthline, and treatments should be chosen with the specific patient in mind. “Right now we're using guidelines meant for the general public, but we need a unique set for people with HIV,” she said.

Myerson has teamed up with HIV specialist Dr. Judith Aberg, also from Mount Sinai, to write a paper on the topic. She said there must be a better understanding about which heart medications are safe to prescribe to people with HIV and which are not.

She said she cannot currently get Medicaid or private insurance companies to pay for some of the medications she believes might help some of her patients with HIV.

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