HIV and Atherosclerosis

[Mishma]

Now this is something I can personally relate to. About 6 years ago I had a DVT below my right knee. I went on Coumadin for 6 months and was taken off it. At this time I was not on a statin as my HDL, LDL and total cholesterol weren't out of line.

2 years later I present at the emergency room with shortness of breath. Creatine kinase comes back negative (elevated in heart attack) and I am in what is called normal sinus rhythm. When I get the ultrasound of my heart the tech tells me I'll live to be 100.

The next day I take the stress test and my heart shuts down about 1/3 of the way into it. No thrombus just a loss of volume and after rest my rhythm returns to normal. The next day I get the gold standard test, the angiogram, and as I'm laying on the table looking at the catheter in my heart on the monitor the cardiologist tells me I have a widow-maker. My left main coronary artery was occluded 75%.

The restriction was in a place where they couldn't do a stent or anigioplasty so a CABG was ordered in two days. I survived the double bypass. The surgeon told me how bizarre the vessels looked in color-but other than the one occlusion the coronary arteries were fine. 

At the time I was on Kaletra and Truvada. Following the surgery I was prescribed 80 mg of Pravastatin and 325 mg of Aspirin per day.

Despite near normal cholesterol, HDL, LDL and sugar I nearly died. If you are over 50 with HIV (with or without meds) it would be in your best interests to get a stress test.

From American Heart Journal
Parallel Increase of Subclinical Atherosclerosis and Epicardial Adipose Tissue in Patients With HIV
Stefano Zona, MD; Paolo Raggi, MD; Pietro Bagni, MD; Gabriella Orlando, MD; Federica Carli, MD; Guido Ligabue, MD; Riccardo Scaglioni, MD; Rosario Rossi, MD; Maria Grazia Modena, MD; Giovanni Guaraldi, MD

Authors and Disclosures
Posted: 07/26/2012; Am Heart J. 2012;163(6):1024-1030. © 2012 Mosby, Inc.
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Abstract and Introduction
Methods
Results
Discussion
References
Abstract and Introduction

Abstract

Background Epicardial adipose tissue (EAT) may contribute to the development of coronary atherosclerosis via paracrine secretion of inflammatory cytokines.
Methods This is a prospective, observational study of 240 consecutive HIV-infected patients receiving antiretroviral therapy. All patients underwent 2 sequential chest computed tomographic scans to assess the change in coronary artery calcium (CAC), a marker of subclinical atherosclerosis, and EAT volume. Patients with known cardiovascular disease were excluded. Factors independently associated with EAT change were explored using multivariable linear regression analyses. The association between EAT increase and CAC progression was explored using logistic regression analyses.
Results Two hundred forty patients were included. Patients' mean age was 47.5 ± 8 years, and 68% were men. The median interval between computed tomographic scans was 18.7 months (interquartile range 10-27 months). Men showed a larger increase in EAT (5 ± 14.2 cm3) than did women (−0.45 ± 8.8 cm3, P = .007). Factors independently associated with change in EAT were CD4+ recovery (β = 0.43, CI 0.05-0.82) and male gender (β = 5.65, CI, 1.05-10.26). Change in EAT was independently associated with CAC progression (odds ratio 1.04, 95% CI 1.004-1.88, P = .030) after adjusting for traditional cardiovascular risk factors.
Conclusions In this cohort of patients with HIV receiving antiretroviral therapy, male gender and CD4+ were independent predictors of EAT increase, and there was a parallel progression of CAC and EAT. Abnormal immunoreactivity associated with T-lymphocyte recovery should be further studied as a determinant of atherosclerosis progression in HIV-infected patients.

http://www.medscape.com/viewarticle/766085?src=nl_topic

[hopeisvague]

Though without written guidelines to support, I deem it necessary to take into account: HIV infection as a risk factor of cardiovascular disease (CVD) despite generally healthy blood parameters.

U.S. Preventive Services Task Force (USPSTF) has issued guideline http://www.ahrq.gov/clinic/cvd/aspprovider.htm regarding using aspirin for primary prevention of CVD. As in Mishma's case, he takes aspirin as a secondary prevention.

Yet I wonder if younger HIV positives, like me in my early 30s, should take a very low dose aspirin with a view to HIV as a chronic inflammation which causes atherosclerosis for primary prevention for CVD as well. Although aspirin is linked to gastrointestinal bleeding, co-administration with equal dose of vitamin c http://www.huffingtonpost.com/leo-galland-md/aspirin-and-vitamin-c-tog_b_529058.html seems to be an alternative to alleviate the damage to gastric mucosa.

While we are religiously taking meds daily, staying alive for a cure, we should not let other co-morbidities creep in to steal our health (or take our lives...)

[Common_ground]

What about long term use of aspirin and damage to liver/kidneys or other organs?

I have this idea, the less pills the better, but I have read and heard many taking a baby aspirin so if anyone got more input that would be great.

[Mishma]

http://www.medscape.com/viewarticle/768522?src=nl_topic

From Reuters Health Information
Post-MI Hospital Mortality Higher for HIV Patients
 
By Anne Harding

NEW YORK (Reuters Health) Aug 01 - HIV-infected patients are more likely to die in the hospital after an acute myocardial infarction (AMI) than patients without HIV, according to a new analysis of data from the Nationwide Inpatient Sample.

HIV patients were also less likely to have undergone several typical in-hospital procedures for treating acute AMI. Their mortality risk was still 38% higher after the researchers took this and other relevant factors into account.

"This is the first study we know of to document disparities in treatment processes for AMI in seropositive patients, and although we cannot explicitly ascribe our observations to discrimination in the process of care, further studies may be required to explore the underlying explanatory factors associated with this observation," said Dr. Daniel Pearce of California's Loma Linda University and his colleagues.

Their data from the Nationwide Inpatient Sample was collected between 1997and 2006 on 2.5 million HIV-negative patients and nearly 6,000 HIV-positive patients hospitalized for AMI for more than one day. The lower and upper age limits for the study were 18 and 65.

The HIV-positive patients were younger, more likely to be male, and more likely to have Medicare or Medicaid insurance. Their score on the Charlson co-morbidity index was 1.14, compared to 0.94 for HIV-negative patients. HIV-positive patients were more likely to have renal disease, liver disease, and congestive heart failure, but they were less likely to have dyslipidemia and less likely to use tobacco.

They were also less likely than HIV-negative patients to undergo left-sided cardiac catheterization (52% vs 66%), coronary arteriography (48% vs 63%), angiography of left-sided cardiac structures (44% vs 56%), or coronary artery bypass surgery (6% vs 14%). HIV patients also received thrombolytic or anticoagulant therapy less often (18% vs 22%).

After adjustment for age, race, gender, comorbidities, dyslipidemia, hospital type and number of in-hospital procedures, the HIV-positive patients were 1.38 times more likely to die in the hospital than the HIV negative patients.

There are a number of limitations to the data used in the current study, Dr. Pearce noted in an interview with Reuters Health. For example, it is not clear which patients had AIDS, and also smoking and use of illegal drugs is often not captured by hospital discharge data.

Nevertheless, he added, clinicians should be aware of the higher AMI mortality risk for HIV-positive patients identified in the current study. "We should be a little more vigilant to make sure we are offering them the same care," Dr. Pearce said. "We need to do another study to tease out the reasons for this."

His study appeared online July 4 in the American Journal of Cardiology.

[Mishma]

http://www.medscape.com/viewarticle/768435?src=nl_topic



Relative Risk of Cardiovascular Disease Among People Living With HIV
A Systematic Review and Meta-analysis
FM Islam; J Wu; J Jansson; DP Wilson
Authors and Disclosures
Posted: 08/20/2012; HIV Medicine. 2012;13(:453-468. © 2012 Blackwell Publishing
   
 
Abstract and Introduction
Methods
Results
Discussion
References
Abstract and Introduction

Abstract

Objectives The aim of this study was to estimate the relative risk of cardiovascular disease (CVD) among people living with HIV (PLHIV) compared with the HIV-uninfected population.
Methods We conducted a systematic review and meta-analysis of studies from the peer-reviewed literature. We searched the Medline database for relevant journal articles published before August 2010. Eligible studies were observational and randomized controlled trials, reporting CVD, defined as myocardial infarction (MI), ischaemic heart disease, cardiovascular and cerebrovascular events or coronary heart disease among HIV-positive adults. Pooled relative risks were calculated for various groupings, including different classes of antiretroviral therapy (ART).
Results The relative risk of CVD was 1.61 [95% confidence interval (CI) 1.43–1.81] among PLHIV without ART compared with HIV-uninfected people. The relative risk of CVD was 2.00 (95% CI 1.70–2.37) among PLHIV on ART compared with HIV-uninfected people and 1.52 (95% CI 1.35–1.70) compared with treatment-naοve PLHIV. We estimate the relative risk of CVD associated with protease inhibitor (PI)-, nucleoside reverse transcriptase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based ART to be 1.11 (95% CI 1.05–1.17), 1.05 (95% CI 1.01–1.10) and 1.04 (95% CI 0.99–1.09) per year of exposure, respectively. Not all ART was associated with increased risk; specifically, lopinavir/ritonavir and abacavir were associated with the greater risk and the relative risk of MI for PI-based versus non-PI-based ART was 1.41 (95% CI 1.20–1.65).
Conclusion PLHIV are at increased risk of cardiovascular disease. Although effective in prolonging survival, ART (in particular PI-based regimens) is related to further increased risk of CVD events among people at highest initial absolute risk of cardiovascular disease.