The development of anti-retroviral medication has changed the face of HIV (human immunodeficiency virus). Now, people with HIV are living longer and healthier lives. However, research is now showing that those who are HIV positive may be at greater risk for cardiovascular disease, such as strokes, blockages in arteries bringing blood to the heart muscle and heart attacks. Cardiovascular disease is predicted to become one of the leading medical problems in patients with HIV.
Why Cardiovascular Disease and HIV?
The reasons for this connection are many. Experts feel that the HIV virus itself increases risk. The anti-retroviral medications—in particular, the protease inhibitors—change metabolism and cholesterol. Recent research also suggests that patients with HIV develop something similar to “metabolic syndrome,” a cluster of abnormalities including hypertension, high triglycerides, low HDL-cholesterol (the “good” cholesterol), elevated blood glucose and larger waist sizes. And, people with HIV are now living to an age where stroke and heart disease are more common in general.
Recognizing and treating this cardiovascular risk is important, especially in the New York City metropolitan area where there are large numbers of persons living with HIV. Because of this, St. Luke’s and Roosevelt Hospitals’ Victoria Sharp, MD, founder and director of the Center for Comprehensive Care (CCC) HIV clinic, invited me to lead a clinic section dedicated to diagnosing and treating risk factors for cardiovascular disease. The CCC is at the forefront in care for patients with HIV.
Understanding Your Risk
For patients living with HIV, there are things to do to help reduce your risk for cardiovascular disease. You should review your risk factors with your health care provider and together make a plan to reduce your risk and get heart-healthy. As mentioned, the anti-retroviral medications can change your cholesterol and lipids, but it is generally important to stay on the medications that your provider has chosen for you.
Genetic and Non-Modifiable Risk Factors
There are risk factors that you can’t do much about , such as:
* Family history of premature cardiovascular disease (a first-degree male relative with cardiovascular disease diagnosed under the age of 55 and a first-degree female relative with cardiovascular disease diagnosed under the age female 65) .
* Age 45 and older for men, 55 and older for women.
* Medical conditions such as diabetes and pre-diabetes, high blood pressure (hypertension) , and abnormal lipids (high LDL-cholesterol, high triglycerides and low HDL-cholesterol).
Lifestyle Factors That You Can Control
Here are risks you can modify, such as:
* Tobacco use. Stop smoking and stay away from secondhand smoke.
* Sedentary lifestyle. Work with your doctors to get active.
* Being overweight and or having a poor diet. Work with your doctors and a nutritionist to get to and maintain a healthy weight through better food choices.
Merle Myerson, MD, is the Director of the Cardiovascular Disease Prevention and Pre-Exercise Heart Screening Programs at St. Luke’s and Roosevelt Hospitals, and Director of the Cardiology Section for the Center for Comprehensive Care/HIV Clinic.