Cardiovascular disease and prevention among people living with HIV in South Florida

Abstract

Antiretroviral therapy (ART) has improved survival of patients living with HIV (PLWH); however, this has been accompanied by an increase in cardiovascular disease (CVD). Although preventative measures for CVD among the general population are well described, information is limited about CVD prevention among PLWH. The goal of this study was to characterize the prevalence of CVD in our population and to assess the use of primary and secondary prevention. We performed a retrospective review of PLWH receiving primary care at a large academic center in Miami, Florida. We characterized the prevalence of CVD, CVD risk, and the use of aspirin and statins for primary and secondary CVD prevention. A total of 985 charts were reviewed (45% women, 55% men). Average age was 52.2 years. Average CD4 count was 568 cells/microL. 92.9% were receiving ART, and 71% were virologically suppressed. The median 10-year ASCVD risk was 7.3%. The prevalence of CVD was 10.4% (N = 102). The odds of having CVD was lower in patients on ART (OR 0.47, 95% CI: 0.25–0.90, P = .02). The use of medications for primary and secondary prevention of CVD based on current guidelines was low: 15% and 37% for aspirin respectively, and 25% and 44% for statins. CVD risk and rates of CVD are high among PLWH and receiving ART could protect against CVD. However, the use of medications for primary and secondary prevention is low. Increased awareness of CVD risk-reduction strategies is needed among providers of PLWH to decrease the burden of CVD.

Enfermedades cardiovasculares y metabólicas en pacientes infectados por el Virus de Inmunodeficiencia Humana: Epidemiología y diagnóstico.

“…Ge y col (Ge & Brown, 2020) añaden la determinación del perfil lipídico, prueba de esfuerzo cardiaco, tomografía computarizada cardiaca, el uso de estas pruebas pueden ayudar a reducir la mortalidad por enfermedades cardiovasculares a través de una detección más temprana de la enfermedad o una evaluación de riesgo más precisa. Pyarali y col (Pyarali et al, 2021) destacan la utilidad de la medición de células T CD4 y determinación del perfil lipídico, se demostró que el recuento de CD4 tiene un efecto protector mínimo contra la ECV. Particularmente Woldoyes y col. (Woldeyes et al, 2022b) mencionaron que la ecocardiografía es un método diagnostico no invasivo mucho más detallado y de gran valor, el cual evidencia la prevalencia de múltiples anomalías cardiacas en pacientes con VIH.…”

A Systematic Review of How To Reduce Morbidity in HIV Patients With Cardiovascular Diseases

“…It is estimated that several factors contribute to cardiovascular mortality in PLWH. One of them is the increased life expectancy in PLWH and the age-related cardiovascular changes; others include HIV infection, poor infection control, chronic inflammation, immunologic progression (low CD4+ cell count), and ART-mediated cardiometabolic dysfunction [7,15,19].…”

“…The therapy consists of two nucleoside reverse transcriptase inhibitors (NRTI) and one protease inhibitor (PI) or one non-nucleoside reverse transcriptase inhibitor (NNRTI) or one integrase inhibitor and a C-C chemokine receptor 5 (CCR5) inhibitor [21]. Previous research concluded that, besides their substantial benefits, ART is associated with metabolic changes and increased CVD risk, including atherosclerosis [3,6,7,16]. Few antiretroviral drugs are known to induce OS by several biochemical reactions.…”

“…It was also found that an increased duration of exposure to HAART decreases the incidence of heart failure [9]. Therefore, we need to focus on improving cardiovascular health by implementing screening and preventive strategies to reduce CVD mortality and morbidity [7].…”

The role of gut-derived oxidized lipids and bacterial lipopolysaccharide in systemic inflammation and atherosclerosis

“…Despite the introduction of potent antiretroviral therapy (ART), despite achieving undetectable virus levels in blood, many patients with chronic treated human immunodeficiency virus (HIV) have evidence of continued inflammation and increased risk of cardiovascular disease [ 46 ]. The continued inflammation is thought to be attributed to the persistence of intracellular virus (e.g.…”