Forbes: HIV Drugs may raise heart attack risk!

[thirtysomething]

Check this out.. Now one more thing to worry about!    And worse, almost everybody who is dead in my family and near relatives have died of Heart Attack!

http://www.forbes.com/forbeslife/health/feeds/hscout/2007/04/25/hscout603990.html

[xyahka]

The only thing that will cause me a heart attack regarding hiv drugs... will be their price!!! 

[J.R.E.]

Just got this in my email box this morning, from aidsmap : Similar article

"Are people with HIV at higher risk of heart disease? Further research suggesting an elevated risk was published this week, and its conclusions are sobering.

HIV-positive people receiving treatment at two major US hospitals were 75% more likely to experience a heart attack, and women were almost three times as likely to experience a heart attack as their HIV-negative counterparts.

The findings could not be entirely explained by the presence of elevated cholesterol levels, high blood pressure or diabetes.

There are several reasons to think that the findings of the study, carried out by Steven Grinspoon and colleagues at Massachusetts General Hospital, are robust.

Firstly, the study had a very large control group of HIV-negative patients, and a substantial number of patient-years of HIV-positive follow-up.

Secondly, the researchers chose one hard endpoint – myocardial infarction – rather than the spectrum of cardiovascular disease investigated in some other studies.

Thirdly, the study had a higher proportion of African-Americans than other studies, and one-third of the HIV-positive patients were women, making its findings more representative of the HIV-positive in the United States than other studies, such as review of the Kaiser Permanente database in California.

Analysis of the DAD cohort, which looked at HIV-positive patients in Europe and Australia also found that the elevation in risk might be as much as threefold, but they also found that the year-on-year risk of heart attack was probably around 1% based on their data.

In other words, although these findings are sobering, they shouldn’t discourage anyone from taking antiretroviral therapy.

What they should do is encourage far greater discussion of risks for heart disease between doctors and patients. The Boston researchers found that they had data on the smoking habits of only 22% of their HIV-positive patients, despite the fact that patients were followed until 2004, when the risk of cardiovascular disease was already being widely discussed by HIV doctors.

More research is clearly needed in this area, but the findings add further weight to the case for choosing antiretroviral regimens that don’t add to the risk of heart disease, and for smoking cessation advice to be given high priority in the work of any HIV clinic."



Ray

[ndrew]

I suppose there are worse ways to go... like drowning or dying in a fire...

[allopathicholistic]

Thanks for sharing that link. It says The findings, published in the April 26 issue of the New England Journal of Medicine, come on the heels of a related study published Tuesday in the Journal of Clinical Endocrinology and Metabolism. That research, by a team at Harvard Medical School, found that HIV infection -- and possibly, treatment -- boosted rates for heart attack nearly twofold. I say toss in a few dozen bottles of red wine and start the study over.  Ugh, what can we do?

[MariaDee]

Great....
I was looking for more good news....
I've been poz for a little over a year and already, my blood pressure is through the roof, just found out Friday that my cholesterol is way off the charts, I'm extremely depressed, and now I can look forward to maybe having a heart attack among other things of course that I have yet to experience.

Go ahead give it to me..... 'welcome to being poz'

[BT65]

Hey Maria:
  All I can say is "welcome!"  My cholesterol was always normal, UNTIL I started the antiretrovirals.  Then it doubled!  Good luck!

[MariaDee]

Thanks Betty.....
So it is the meds?  My doc said I needed to watch what I eat.  I didn't think it was my diet 'cause nothing has changed. 

[RapidRod]

I have to see the cardiologist twice a year anyway, so this isn't going to add any more worry on me.

[Matty the Damned]

It's things like this which make Matty the Damned grateful he doesn't have a heart.

MtD

[Iggy]

This is what many of the LTS have been telling this board for a long time now.  When I say "this" I don't necessarily mean this specific study, but the point that many have been trying to let us know (often to deaf and defiant ears) that the very treatments that we are taking to fight HIV are having, or have the potential to have, profound negative effects on the rest of our body.

There are many here who have talked openly about their heart issues as well as liver, kidney, eyes, joints and just about ever part of the body that they feel is starting to weaken if not outright fail because of the treatments - not HIV.

This is why so many of them have gotten frustrated at others talking about this being a manageable disease- because it is a false argument as it is not the disease that we have to manage anymore but the very treatments and side effect (both short and long term).  On a related side note - it has always angered me when others who are not experiencing such effects  are are new on treatments are the ones to state to them that maybe it's just old age or that they are being overly negative.

I hope you don't see my response as unsympathetic - it's not - I very much fear as you do my heart developing problems someday.  I also hope you don't see this as some rally not to follow your regimen - It's not.

What this is however is a hope that more people will realize that though we've come a long way in treatments and the ability to extend our life spans as HIV poz people - we need to be aware that living with HIV has for most of us (whether we know it or not) moved from a direct fight against HIV to a fight against to collateral damage of the treatments  and we should not be lulled into complacency because the battle is not an obvious one.

[J.R.E.]

This is what many of the LTS have been telling this board for a long time now.  When I say "this" I don't necessarily mean this specific study, but the point that many have been trying to let us know (often to deaf and defiant ears) that the very treatments that we are taking to fight HIV are having, or have the potential to have, profound negative effects on the rest of our body.

Absolutely !! I've known this for this for a quite a while. Having friends, that have had strokes in their 40's and open heart surgery-- well.....

I think a many of the newly infected may not like to hear or read this news, but the fact is, it's out there. Which is one more reason, why we have to take care of ourselves to the best of our abilities.

I have always thought , that it will be a stroke or heart attack, or some heart disease, that will do me in, I've seen it happen to others before.



Ray

[bocker3]

I think a many of the newly infected may not like to hear or read this news, but the fact is it's out there. Which is one more reason, why we have to take care of ourselves to the best of our abilities.

Ray,
I think that you have hit the nail on the head.  Being only 2 years into this, I try very hard (with up and down success) to focus on the positive, but NOT ignore the rest.  I may be having a pretty easy time of it right now, but I've read enough here and elsewhere, to know that this can change.  Of course, I also need to remember that I didn't know what was going to kill me before HIV and I still don't know what (or when) will now.  Therefore, I try to take care of myself -- I eat better than I used to, but still have room for improvement and I exercise much more regularly now.  Heart diseases has killed the majority of men in my family for generations, I started on statins 11 yrs ago because of my cholesterol.  It is currently well managed, even with my hiv meds, but heart disease has always been my most likely grim reaper.  If my meds end up causing my heart to kill me in 20, 30, 40 yrs -- so be it -- I know that without them I wasn't likely to make it 10 more.

In the article from the original link in this post, there was a very interesting paragraph:
Writing in an accompanying editorial in the journal, Dr. James Stein, of the University of Wisconsin School of Medicine and Public Health, said the actual increase of risk for heart attack from protease inhibitors "is not high." In fact, it remains much smaller than the danger posed by more typical risk factors such as aging, smoking and diabetes.

I think this speaks to one of your points -- take care of yourself.  It almost seems silly to worry about the increased risk in heart disease from life saving medicines when one continues to smoke or continues other behaviors that put your heart at risk.  So, taking care of ourselves is key.  Of course, we can't do anything about aging, so we need to simply accept that one, 

Finally, we need to remember that our individual journey with HIV is our own.  We won't necessarily run into the same complications as others, but then again, we may.  It's important to pay attention, learn and be aware, but worry, in general, is unhelpful and worry without action is simply a waste.

Mike

[aztecan]

I am currently going through some of the "oopsies" that come along with long-term ARV usage.

Don't get me wrong. I am glad to have had them and will deal with whatever comes along. But I think it is naive to think it will be a walk in the park with a "manageable disease."

I think Mike and Ray make very important points. We may not be able to do anything about some of the risks we are exposed to, but we can act to live a healthier life and reduce the risks we do have control over.

I have given up smoking. OK, I just gave up smoking 90 days ago, but still, at least its a start. I exercise three times a week for 90 minutes, including a cardio routine. I try to watch my diet, although I have gained a few pounds since quitting ciggies.

No matter what I do, I will have HIV. No matter what I do, I am experiencing some long-term side effects of the meds. That's life. I am now looking at what I can do to curtail or reduce these side effects.

There may be naught. But its at least worth some research.

The bottom line here is not just to live longer, but to live longer well. If I can pull that off I will be a happy camper. I don't know, maybe I started too late. But we'll see.

But for the many out there who are still young, strong and vibrant - do what you can do to stay that way. Well, strong and vibrant anyway. Aging is another ball of wax.

I have said it, so has Moffie and others. You are the guardian of your own health.

HUGS,

Mark

[StrongGuy]

I read that article expecting the study to uncover some new revelation about HIV drugs and heart disease --  but it just reiterated what I've been hearing for many many years about the Protease inhibitors (their lack of lipid friendliness) and increased risk for heart disease.

When I started Kaletra that was one of the first "risks" my doctor mentioned to me. It was also one of the reasons (along with a daily wave of nausea after taking - albeit very manageable otherwise) that made me decide to switch over to Sustiva/Truvada when my doc felt it was OK to do so. Any doctor who put/puts patients on PIs (sans Reyataz which is lipid friendly and less troublesome) and has not/does not (prior to this study or not) have a discussion with their patients about increased risk for heart disease on Protease Inhibitors should have their licenses revoked. This news has been around for long while - study or not.

With that said, at least when I was on Kaletra I knew the pros and cons and the "small but significant hike in risk" for heart disease was worth the alternative. What pisses me off more is when my doctor gave me a script for Celebrex - take it when my knee acts up - and then hear after taking it for awhile that the whole class of COX-2 Inhibitors causes a statistically significant increase in heart disease. Surprises like that pisses me off more.

Mikey

[aztecan]

Back when I started Crixivan, they didn't know about the lipidemia associated with it.

What I found interesting in the article linked to in this thread was the evidence there is some risk of heart complications simply as a result of HIV infection.

There are a few people here, and I know some others, who have suffered severe heart complications as a result of HIV, not the meds.

All we can do is take the steps we are able to and hope for the best.

HUGS,

Mark

[J.R.E.]

Some good charts and info :


 http://www.thebody.com/content/treat/art1082.html



Ray

[bimazek]

in one of the mags i think poz or the other one

the doctor who has two pages every issue said about 3 or 4 months ago maybe it was more in the fall of 2006

that he sees very soon that a triple cocktail will NOT contain any nukes, non nukes or protease

for

exactly the reasons people are talkign about above

side effects

he feels that new and first line triple cocktails will be things with lower side effects like

integrase and other ones that i forget the name

so that is where we are trying to get

3 drug cocktail without any of the ones that cause problems

the issue is

enzymes that body needs to do fcns when you inhibit them it causes problems in other parts of body that need that enzyme and also

[otherplaces]

I saw this thread right after I read this:
Epidemic of cardiovascular disease in HIV patients `not on horizon`
http://www.aidsmap.com/en/news/B16BC8B7-496C-4EE6-A6B0-B04135D9000F.asp

I'm sure heart disease is elevated with us, but I'm also sure our high level of smoking isn't really helping the numbers either. **sigh** so good, but soooo bad.

I think bimazek is right.  With integrase and entry inhibitors about ready to hit prime time, and maturation inhibitors right behind 'em they will be looking to see if these are going to be better classes to use for treatment.  PI's and NRTI's could become part of 3rd and 4th line regimens in the not too distant future.

brian

[Jake72]

""This effect was likely explained by a complex process where untreated HIV depletes the 'good' (HDL) cholesterol," he said."

Good God, is there anything that damned virus can't do?   

[Miss Philicia]

I've had high blood pressure for the past year (well, it's controlled now with Diovan)... thankfully it wasn't dangerously high.  And it's not due to anything like bad lifestyle as I'm a quite trim person, except for some PI related belly fat which can't be helped.  It's minimal though... I can still wear 31" jeans.

I do worry about all these "other" issues.  Someone I semi-know just passed away from lymphatic cancer, complicated by long-term HIV infection.