Heart Disease and HIV

A recent article in the New York Times highlighted the increased risk of heart disease in patients with HIV. (www.nytimes.com/2012/06/19/health/heart-attacks-are-much-more-frequent-in-hiv-patients.html?_r=1&pagewanted=all)  I’m always glad to see articles about HIV in the newspaper.  It’s important for the public to be informed and up-to-date on issues that relate to this epidemic.  I was surprised, however,  that the article presented the link between HIV and heart disease as a new phenomenon, or something that HIV doctors and cardiologists have not been aware of.  There has, on the contrary, been tremendous interest, research and discussion of this topic going back to the late 1990s, when it became apparent that some patients were seeing marked increases in their cholesterol and triglyceride levels while taking the new protease inhibitors.  Further research has looked into the role of inflammation in coronary artery disease and the contribution of heightened immune function to this condition.  

We know from studies involving thousands of patients that there are a number of HIV-related factors that directly or indirectly contribute to increased risk of heart disease in those infected with HIV.  All of this research has concluded that there is an incremental increase in risk of heart disease just from being HIV positive.  This incremental risk can be added to the risk attributed to higher lipid levels in those taking protease inhibitors, higher rates of diabetes linked to older protease inhibitors, higher rates of smoking among patients with HIV and increased inflammatory markers in untreated patients.  The increment from HIV alone is very small next to the well-known, previously established risks.  Male sex, age over 42, smoking, family history, hypertension and diabetes are all significantly more important as risk factors for heart disease.  Smoking is a particularly bad problem in HIV patients; nearly half of all patients with HIV are smokers (as opposed to less than 30% of the general population).  So the link between HIV and heart disease is not a development.  It’s good to be aware of it but keep those major risk factors in mind if you hear of an HIV patient having a heart attack.