Higher risk of sudden heart event for people with HIV

"I had no idea that since I have HIV, I may be twice as likely to have a heart event compared to the general population," said Frank Carroll, a 63-year-old man who has been living with HIV for over two decades.

Unfortunately, that is the case for the majority of people who are living with HIV. Up to this point, there has been very little research conducted regarding heart disease and HIV, but here is what we do know:

People with HIV often have what is known as "inflamed non-calcified plaque" buildup in the heart. This plaque is considered "high risk" plaque because it is a leading risk factor for heart disease. This is important to know because "inflamed non-calcified plaque" is extremely vulnerable to rupture and that can lead to a sudden heart event, such as a heart attack. Traditional risk factors, including high blood pressure and high cholesterol, are well-known contributors to heart disease for those with HIV and the general population. However, an additional and significant HIV-related risk factor for developing heart disease is constant activation of the immune system; this happens even with antiretroviral therapy and when the virus is undetectable.

Heart disease rates among people living with HIV are elevated compared to the general population. If you add to that the fact that heart disease is often a silent killer with atypical symptoms, it is easy to understand why more research needs to be conducted on this subject.

It is important that health care providers gain a better understanding of the intersection of HIV and heart disease to inform how they educate, treat, and monitor patients. It is equally important that heart disease prevention tools are developed and tested, specifically among people living with HIV, to determine the most effective ways to treat and prevent heart disease events in these patients.

"We know that people with HIV are living longer and aging. The HIV community has worked very hard for these successes; they have participated in research studies for the past 30 years to help develop antiretroviral therapy that works to suppress HIV. It is our goal now to find ways to keep people with HIV healthy as they age and help them achieve a full and healthy lifespan," said Dr. Steven K. Grinspoon, Director of Massachusetts General Hospital Program in Nutritional Metabolism and Professor of Medicine at Harvard Medical School.

Gaining a better understanding of how HIV may contribute to heart disease and determining effective prevention strategies will enable health care providers and patients to act before significant damage and co-morbidities develop. The time to take action is now, before this silent killer strikes.

Be Proactive About Heart Health

"I never really thought I would live to be an old man, so it was not until a few years ago that I made the decision to take control of my overall health. I quit smoking and am now more conscious of my diet and exercise activities than in the past. Research has come a long way in helping people with HIV, but there are many things we can do as patients to help ourselves as well," said Mr. Carroll.

Members of the HIV community should make it a priority to talk with their health care provider about additional ways to remain heart healthy. There are always helpful resources available at local HIV clinics such as smoking cessation programs, exercise groups, nutrition services, and research studies.

A "whole-body" approach to living longer with HIV is critical. HIV patients and their health care providers alike should understand that there are many pieces to the puzzle when it comes to keeping those living with HIV heart healthy.

"I have treated many patients who were overweight, who smoked, and rarely exercised. In these instances, I always made it a point to explain the risk factors associated with heart disease and the concerns regarding inflamed non-calcified plaque unique to the HIV population. In future visits, many of these patients made lifestyle changes that, in the long run, led to increasingly positive health outcomes," said Dr. Grinspoon.

Although smoking cessation, eating a healthy diet, and exercising are excellent ways to stay healthy, clearly, there are more tools needed to prevent heart disease among people living with HIV.