HIV & Heart Disease: Minimize Your Risk.
HIV & Heart Disease: Minimize Your Risk.
People living with HIV have a higher risk for heart disease, by up to 1.5 to 2 times higher than the general population. And, research shows that traditional methods of assessing heart disease risk are not as effective for people living with HIV.
What’s the connection between Heart Disease & HIV?
There are three factors that increase your risk for HIV:
Natural process of aging. As HIV treatment has become more effective, people who are HIV-positive live longer, and as a result, experience age-related diseases like heart disease and diabetes. However, people with HIV experience these conditions at younger ages than the general population.
HIV-related inflammation. HIV affects your immune system. CATIE explains: ‘The ongoing replication of the virus in your body causes your immune system to be in a constant state of high-level inflammation.” This continuous inflammation damages and degrades tissues and accelerates the ageing of blood vessels. Being on treatment greatly reduces the inflammation in your body as a result of HIV, however, low level inflammation persists, and may increase the risk of heart disease over the long-term.
Some medications used to treat HIV may increase the level of triglycerides in the blood, raising your cholesterol and increasing the risk for heart disease. According to POZ, many protease inhibitors, some NNRTIs and a few NRTIs, have been found to affect cholesterol and triglyceride levels in people with HIV. These are mostly older medications. Newer research like the SMART study, shows in general that taking HIV meds actually protects against heart disease.
What other factors affect my risk for heart disease?
Traditional risk factors for heart disease are just as relevant to people living with HIV as everyone else. These include diabetes, high blood pressure, family history / genetics, smoking, poor diet, lack of exercise, stress, depression, sleep apnea, use of street / party drugs and gum disease.
What tools are available to assess my risk for heart disease?
Traditional assessment tools like the Framingham risk score, underestimate heart disease risk among people living with HIV, because some factors, like, increased arterial plaque buildup, don’t match up with other criteria like elevated lipids and age.
The long-running D:A:D study (Data Collection on Adverse Effect of Anti-HIV Drugs) created a model in 2016 that clinicians could use to augment traditional risk assessments for heart disease. This model, in addition to traditional risk factors, includes HIV-specific indicators such as a patient’s CD4 count and the HIV drugs they have taken in the past. After testing the efficacy of this model (results were just published in August 2021), they found that it underestimated heart disease risk significantly. Where the model predicted that 3% of the test group would end up with heart disease over 5 years, in fact, 9% had a cardiovascular-related event. Increased prevalence of factors such as diabetes and family history could have contributed to the findings, as well as lower CD4 counts among the test participants. Despite the limitations of D:A:D model, it still provides a better framework for assessing heart disease risk among people living with HIV than other traditional measures.
So, what should I do to reduce my risk of heart disease?
People living with HIV are at higher risk for heart disease, period. Here are three things you can do:
Take action and improve your lifestyle - exercise more, eat more healthfully (reduce processed / prepared foods, and cook at home as much as possible), maintain good oral health, and quit smoking.
Stay regular with your HIV meds to reduce inflammation and minimize damage to your blood tissues, and all other medications prescribed by your doctor.
Have a good relationship with your doctor – an HIV specialist is best. Make sure to keep your regular appointments with your doctor, do the required blood work, and keep the lines of communication open when it comes to your family history of heart disease and other illnesses, and your overall health.
What about taking baby aspirin?
Current medical thinking on baby aspirin has evolved. Taking baby aspirin daily is not recommended to prevent heart disease. For most people, the risk of internal bleeding outweighs the benefits of heart disease. Talk to your doctor or pharmacist if you have questions.
Get in touch if you need help with HIV and your heart:
We’re always here at The Village Pharmacy to answer your questions about managing HIV and other conditions. A MedsCheck review can give you a broader understanding of all the medications you’re on, help identify any issues, and give you strategies to take them regularly. If that’s too much commitment, feel free to ask the pharmacist next time you come in to pick up your medications. And, if you’re looking for an HIV-specialist doctor, we may be able to help. We’re here for you.
All the best,
Zahid
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Zahid Somani, RPh
Owner-Pharmacist
The Village Pharmacy
473 Church Street
535 Yonge Street
www.thevillagepharmacy.ca
References:
HIV and cardiovascular disease - CATIE
Cardiovascular Disease and HIV Infection - Research Study
Even Measures Designed for People With HIV Underestimate Cardiovascular Risk - POZ
HIV and Your Heart - POZ
Youth Doesn’t Protect People With HIV Against Heart Disease - POZ