Cardiovascular Risk and Health Among People With Human Immunodeficiency Virus (HIV) Eligible for Primary Prevention: Insights From the REPRIEVE Trial

Abstract

Background In addition to traditional cardiovascular (CV) risk factors, antiretroviral therapy, lifestyle, and HIV-related factors may contribute to future CV events in persons with HIV (PWH). Methods Among participants in the global REPRIEVE randomized trial, we characterized demographics and HIV characteristics relative to ACC/AHA Pooled Cohort Equations (PCE) for atherosclerotic CV disease predicted risk and CV health evaluated by Life’s Simple 7 (LS7; includes smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and glucose). Results Among 7382 REPRIEVE participants (31% women, 45% Black or African American), the median PCE risk score was 4.5% (Q1, Q3: 2.2, 7.2); 29% had a PCE score <2.5% and 9% scored above 10%. PCE score was related closely to known CV risk factors and modestly (<1% difference in risk score) to immune function and HIV parameters. The median LS7 score was 9 (Q1, Q3: 7, 10) of a possible 14. Only 24 participants (0.3%) had 7/7 ideal components, and 36% had ≤2 ideal components; 90% had <5 ideal components. The distribution of LS7 did not vary by age or natal sex, while ideal health was more common in low sociodemographic index countries and among Asians. Poor dietary and physical activity patterns on LS7 were seen across all PCE scores, including the lowest risk categories. Conclusions Poor CV health by LS7 was common among REPRIEVE participants, regardless of PCE. This suggests a critical and independent role for lifestyle interventions in conjunction with conventional treatment to improve CV outcomes in PWH.

Diet in a global cohort of adults with HIV at low-to-moderate traditional cardiovascular disease risk

“…Although factors unique to HIV, including persistent vascular inflammation and immune activation, play a role in increased CVD risk [24], traditional CVD risk factors are important as well [25,26]. These findings enrich our understanding of modifiable risk factors and highlight that diet quality, while not often assessed in CVD risk assessment, may be an important factor in the large global population of PWH as has been demonstrated in REPRIEVE [27]. Interestingly, total cholesterol and glucose did not demonstrate clinically meaningful changes across diet quality categories.…”

Two decade trends in cardiovascular disease outcomes and cardiovascular risk factors among US veterans living with HIV

“…By describing the temporal rise in CVD and its risk factors, we hope to encourage physicians to have increased vigilance for CVD and its associated risk factors among PLWH. Recent studies have shown only a limited percentage of PLWH achieving ideal cardiovascular health [ 43 ]. While smoking, alcohol use and substance use appear to be on the decline among VLHW, they should still sould be encouraged to work on lifestyle modifications, including but not limited to weight loss, exercise, and diet.…”

Social Determinants of Health on Cardiovascular Disease Prevention in Special Populations: An Overview

“…Undiagnosed and untreated hypothyroidism have significant public health and economic impacts, primarily due to the high costs that come with the complications of the disease [12]. Therefore, screening for hypothyroidism in older women and newborns, treatment, and prevention programs (universal salt iodization) is mandatory in many countries [10,12,17]. Moreover, screening for thyroid disease is beneficial because overt hypothyroidism has non-specific symptoms, and patients with SH are asymptomatic [10,15].…”