Coronary Artery Disease in HIV-Infected Patients: Downside of Living Longer

Lacson, John Charles A.; Barnes, Revery; Bahrami, Hossein

doi:10.1007/s11883-017-0651-4

Cited by 35 publications

(23 citation statements)

References 103 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As summarized above and in the companion article published with this paper [1], there is growing evidence indicating that HIV+ patients are at higher risk for most common causes of SCD, including CAD [15•, 20, 21••, 40–45], cardiomyopathy and myocardial fibrosis [21••, 22, 46], heart failure [4, 5, 47], pulmonary hypertension [48], and some arrhythmias such as prolonged QT interval [49]. However, only a few studies have evaluated the risk of SCD in this population.…”

Section: Cardiac Arrhythmiamentioning

confidence: 99%

“…The mechanisms that are involved in the pathogenesis of CAD in PLWH, as detailed elsewhere [1], can also affect the extra-cardiac vascular system to a varying degree. However, the results of the limited available studies on the involvement of the vascular system have been less consistent than studies on CAD.…”

Section: Vascular Diseasesmentioning

confidence: 99%

“…As discussed in our companion article published in this issue [1], people living with HIV infection (PLWH) now live longer and thus will encounter more chronic diseases that are traditionally associated with aging, such as cardiovascular diseases (CVD). Coronary artery disease (CAD) is one of the first cardiovascular diseases that were reported in the post-ART era and is the most widely studied.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease

Barnes

Lacson

Bahrami

2017

Curr Atheroscler Rep

Self Cite

View full text Add to dashboard Cite

Purpose of Review Cardiovascular disease (CVD) increasingly afflicts people living with HIV (PLWH) in the contemporary era of antiretroviral therapy (ART). Coronary artery disease (CAD) is the most widely studied cardiovascular problem in PLWH; however, less is known about other clinically relevant subtypes of CVD such as heart failure (HF), cerebrovascular disease, sudden cardiac death, pericardial diseases, and pulmonary hypertension. This paper reviews evidence of other subtypes of CVD as emerging issues in the post-ART era. Recent Findings Recent studies have shown that PLWH have higher risk of HF as well as subclinical impairment of left ventricular (LV) mechanics (systolic and diastolic dysfunction) and myocardial abnormalities (fibrosis and steatosis). The underlying mechanisms, however, are not well-understood. A few studies have also shown higher rates of atrial fibrillation and sudden cardiac death in PLWH. Ischemic stroke is the most common stroke type in the post-ART era, with underlying mechanisms like those identified in CAD: chronic inflammation and associated vasculopathy. Studies of great vessels (carotid artery and aorta) and peripheral arterial disease show heterogeneous results. Small subclinical pericardial effusions are common in PLWH in post-ART era. Pulmonary hypertension continues to be an underdiagnosed and potentially fatal complication of HIV infection. Summary PLWH remain at higher risk for all types of CVD including heart failure, stroke, and arrhythmias in the post-ART era. Chronic inflammation may play an important role in this increased risk. More studies are needed to further elucidate the extent of non-coronary CVD in PLWH and the underlying mechanisms for them.

show abstract

Section: Cardiac Arrhythmiamentioning

confidence: 99%

Section: Vascular Diseasesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease

Barnes

Lacson

Bahrami

2017

Curr Atheroscler Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…Cardiovascular disease (CVD) is the leading cause of death worldwide, representing an estimated 30% of all global deaths . This is of particular concern for people living with HIV (PLWH), who have been shown to be at an increased risk for developing atherosclerotic cardiovascular disease (ASCVD) compared with the general population . In high‐income countries, ASCVD is second to cancer as the leading cause of non‐AIDS‐related deaths for PLWH .…”

Section: Introductionmentioning

confidence: 99%

Comparing rates of statin therapy in eligible patients living with HIV versus uninfected patients

2019

View full text Add to dashboard Cite

Objectives Despite an increased risk of atherosclerotic cardiovascular disease (ASCVD) in people living with HIV (PLWH), a gap in statin prescribing practices has been described for statin‐eligble PLWH and uninfected patients. Few data have become available characterizing this gap since the publication of the 2013 American College of Cardiology/American Heart Association lipid guidelines. The objective of this study was to characterize statin prescribing rates for eligible PLWH compared to uninfected adults. Methods This was a retrospective, comparative analysis of patients seen at two clinics in an urban, academic medical system between February 2017 and September 2017. Patients who qualified for one of the statin benefit groups were included: those with a history of clinical ASCVD, low‐density lipoprotein cholesterol ≥ 190 mg/dL, diabetes mellitus, or 10‐year ASCVD risk score ≥ 7.5%. Patients < 21 years old or without a lipid panel within 3 years were excluded. The primary outcome was the percentage of PLWH prescribed a statin compared to uninfected patients. Predictors associated with receiving a statin were analysed using a logistic regression model. Results Nine hundred and eight PLWH and 2239 uninfected patients met the study criteria. A difference in statin prescribing rates was observed between PLWH and uninfected patients (44% versus 56%, respectively; adjusted odds ratio (OR) 0.79; 95% confidence interval (CI) 0.66–0.94). However, only in the 10‐year ASCVD risk group were the rates significantly different (24% for PLWH versus 36% for uninfected patients; adjusted OR 0.68; 95% CI 0.5–0.92). PLWH more often received a medium‐intensity statin and uninfected patients more often received a high‐intensity statin. Conclusions PLWH with ASCVD risk were less likely to be prescribed a statin compared to uninfected patients. Additional analyses are needed to investigate reasons for the statin prescribing gap and appropriateness of lipid agent selection in both study populations.

show abstract

“…Hypertension is a leading risk factor for cardiac disease contributing to 9.4 million deaths annually and an independent predictor of mortality among HIV‐positive adults . Hypertension may be more prevalent among HIV‐positive individuals, due to antiretroviral use or because the virus itself is a risk factor for cardiovascular disease . In many resource‐limited settings, HIV and hypertension are managed separately without communication between providers.…”

Section: Introductionmentioning

confidence: 99%

Integrating hypertension services at an HIV clinic in Port‐au‐Prince, Haiti: A report from the field

Walsh

Lee

Martelly

et al. 2018

J of Clinical Hypertension

View full text Add to dashboard Cite

HIV-positive adults with hypertension have increased risk for mortality but HIV clinics often do not provide hypertension care. We integrated hypertension management into existing HIV services at a large clinic in Haiti. Of 1729 documented HIV-positive adults presenting for care at the GHESKIO HIV clinic between March – July 2016, 551 screened positive for hypertension, with systolic blood pressure ≥ 140mmHg and/or diastolic blood pressure ≥ 90mmHg. A convenience sample of 100 patients from this group received integrated hypertension and HIV care for 6 months. At time of identification, patients were screened for proteinuria and initiated on antihypertensive medication. Hypertension and HIV visits coincided; medications were free. Outcomes were retention in care and change in blood pressure over 6 months. Average blood pressure over 6 months was described using linear mixed-effects model. Of 100 HIV-positive adults with hypertension referred for integrated care, three were ineligible due to comorbidities. Among 97 participants, 82% (N=80) remained in care at 6 months from time of positive hypertension identification. 96% (N=93) were on antiretroviral therapy with median CD4+ count of 442 cells/uL (IQR 257–640). Estimated average blood pressure over 6 months decreased from systolic 160 mmHg (CI 156, 165) to 146 mmHg (CI 141, 150), p-value <0.0001, and diastolic 105 mmHg (CI 102, 108) to 93 mmHg (CI 89, 96), p-value <0.0001. HIV and hypertension management were successfully integrated at a HIV clinic in Haiti. Integrated management is essential to combat the growing burden of cardiovascular disease among HIV-positive adults.

show abstract

Coronary Artery Disease in HIV-Infected Patients: Downside of Living Longer

Cited by 35 publications

References 103 publications

HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease

HIV Infection and Risk of Cardiovascular Diseases Beyond Coronary Artery Disease

Comparing rates of statin therapy in eligible patients living with HIV versus uninfected patients

Integrating hypertension services at an HIV clinic in Port‐au‐Prince, Haiti: A report from the field

Contact Info

Product

Resources

About