HIV Increases the Risk for Heart Attack

It is already clear that HIV infection induces metabolic shifts like impaired levels of cholesterol blood levels, insulin resistance or type 2 diabetes, all correlated to changes of fat distribution.

Now a team at Massachusetts General Hospital (MGH) has linked HIV infection also to a higher risk of heart attack. Even if during the investigation, exposure to some cardiovascular risk factors also got higher for the HIV-infected subjects, the increased level of heart attack was higher than those factors could explain.

"Our study shows a higher incidence of myocardial infarction and major cardiovascular risk factors in HIV-infected patients, compared with non-infected patients," said senior author Dr. Steven Grinspoon, of the MGH Program in Nutritional Metabolism and Neuroendocrine Unit. "Those findings indicate that those infected with HIV should be assessed for cardiovascular risk factors and that we urgently need to develop strategies to modify those risks."

The antiretroviral drugs employed against HIV are already a risk factor for heart attack, but few approaches focused on if HIV-infected patients presented a higher rate of heart attacks than non-infected ones. The team analyzed the Research Patient Data Registry, providing demographic and diagnostic data on over 1.7 million patients treated at MGH and Brigham and Women's Hospital between 1993-2001.

The researchers employed data on almost 4,000 HIV-infected patients and over one million non-infected people, all with ages between 18 and 84, seen at least twice. Those suffering of heart attack at the beginning of the research were excluded from the pool. The risk of heart attack was significantly increased for those infected with HIV, no matter the age.

Even if some cardiovascular risk factors, like high lipid levels, diabetes and hypertension, were common amongst HIV patients, contributing to their higher vulnerability, and even when those values were adjusted, the heart attack levels remained double for HIV patients, and triple among women with HIV infection.

"Followup studies are needed to better determine why myocardial infarction rates are higher in HIV patients, which risk factors drive this risk most, and how smoking - which we weren't able to completely evaluate in this study - affects this risk. We also need to analyze the relationship of antiretroviral medications to cardiovascular risk. HIV medications save lives, and patients should continue taking them as prescribed; but we want physicians to be aware of these increased heart attack rates, watch risk factors carefully and appropriately target their treatment." said Grinspoon, an associate professor of Medicine at Harvard Medical School.