Heart at Increased Risk from HIV Infection

A new study has found that people who are HIV positive can face nearly double the risk of a heart attack than those who are not. The risk remains high across all ages, blood pressure conditions as well as high cholesterol and other cardiovascular risk factors.

The findings are shocking as they suggest that the virus itself or therapies used for treating HIV infection might be harming the heart in some manner. The findings of the study have been reported in the online edition of the Journal of Clinical Endocrinology and Metabolism.

The research team from Harvard Medical School, led by Associate Professor of Medicine Dr. Steven Grinspoon used demographic and diagnostic data for more than 1.7 million patients for their study. All the patients had been treated at Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital, both in Boston, between 1993 and 2001.

The researchers analysed the data and compared outcomes for the nearly 4,000 HIV-infected patients with information on the remaining more than 1 million patients. The HIV-infected patients were aged between 18 and 84 years.

They found that the HIV-patients had overall risk of suffering a heart attack that was twice that of the age-matched control patients. Women were found to be especially at higher risk with heart attack odds nearly tripling after they became infected. Against that, infected men faced a 40% increase in their heart attack risk upon infection.

The research team took into account and adjusted for age and other heart disease risk factors such as high blood pressure, high blood cholesterol and diabetes.

“We don’t know why that is – whether women have more serious metabolic changes or not,” said Dr. Grinspoon, who also directs Massachusetts General Hospital’s Program in Nutritional Metabolism. “Traditional risk factors may be accounting for more of the (heart attack) rates in women than in men, and there may be other things related to body composition that we couldn’t factor in.”

“The link between HIV, the virus that causes AIDS, and heart disease isn’t new,” noted Rowena Johnston, Vice President of Research at the Foundation for AIDS Research (amfAR), based in New York City. “We have certainly suspected that for a long time,” she said.

In 2005, a major European Study, the Data Collection on Adverse Events of Anti-HIV Drugs (DAD) had reported that HIV-positive patients are at nearly twice the heart attack risk in comparison to uninfected individuals of the same age. However statistics from the new study are much more powerful.

The researchers also found a difference in the heart attack risk between black and white patients with black people being at comparatively higher risk. This led researchers and experts to the question of whether HIV is capable of increasing heart risk on its own. However the researchers haven’t been able to find an answer to the question yet.

“HIV is a virus, so (infection) is an inflammatory state,” Dr. Grinspoon said. Chronic inflammation has recently been linked to cardiovascular disease, so “one hypothesis would be that these patients have a pro-inflammatory condition,” he said.

The researchers noted that most of the HIV-infected patients in the study were also taking the powerful cocktail of HIV-suppressing drugs collectively known as “highly active antiretroviral therapy” (HAART).

On the one hand, “HAART suppresses inflammation, which can improve cardiovascular parameters,” Dr. Grinspoon noted. “But, on the other hand, treatment with HAART also leads to worsening changes in body composition and has even more adverse effects on (blood) glucose, lipids, etcetera. So, it’s a mixed bag.”

“We don’t mean to scare people off their meds – they need to take the meds to survive. But doctors should also be aware of this increased risk,” said Dr. Grinspoon. “Other factors may also boost heart risk for people with HIV,” Johnston added.

Commenting on the study population, she noted that the HIV-infected participants were more likely to smoke heavily. In her opinion this was not surprising considering the fact that they were living under the stress caused by the virus. And smoking in itself is a major risk factor for heart disease, she added.

Johnston emphasized that the findings should not make patients wary of taking their medications. “There’s no doubt that antiretroviral therapy is saving lives, regardless of whether there’s an increase in (heart attack),” she said. “The benefits of antiretroviral therapy certainly outweigh those risks.”

At the same time Johnston advised doctors caring for people living with HIV to be vigilant in tracking the cardiovascular health of their patients. Agreeing with Johnston’s advice, Dr. Grinspoon added, “Doctors need to be aware of this increased risk, and that it occurs even among young HIV patients.”

“Sometimes with (young) patients who might have chest pain, you might not ordinarily be concerned, but we are suggesting that doctors pay serious attention to that, because there is this increased risk of cardiovascular disease.”

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