Heart disease

Why discuss heart disease?

When lipodystrophy and metabolic changes associated with combination therapy became more widely recognised, there was an initial concern that these symptoms – particularly increased cholesterol and triglycerides – could lead to an increased risk for heart attack or stoke.

This is because increased levels of blood lipids can lead to blocking blood vessels (atherosclerosis) and are a well-established risk factor for heart disease. Although heart disease can be a disease in itself, it is important to include information about this in a book about side effects of HIV drugs.

This concern was prompted by a series of case reports of heart attacks in HIV-positive men who were too young to be considered as traditionally at high risk.

Several large studies have reported results that calm some of these initial fears.

There is a lot of information and research about risk factors for heart disease in HIV-negative people. This has often come from very large studies (Framingham, Caerphilly etc) that followed a large group of people for many decades. These studies led to the development of risk calculators that are easy to access online.

If you put in your age, gender, cholesterol and triglyceride levels and other risk factors such as smoking, you get your 5-year or 10-year risk of heart disease.

People with high risk factors for heart disease who need HIV treatment, should use newer HIV drugs that have the least risk of increasing the risk of cardiovascular disease any further, and receive support for lifestyle changes. It is hoped that the most ‘lipid-friendly’ HIV drugs will not have the same impact on cardiovascular risk as combination therapy in the D:A:D study.

Risk factors for heart disease

The following factors increase the risk of heart disease – some of which are fixed and some are modifiable by lifestyle.

Fixed risk factors:

Modifiable risk factors:

Symptoms of heart attack or stroke

Symptoms of cardiovascular disease include:

. Additional symptoms for a stroke include:

If you experience these symptoms, you should seek urgent medical attention.

Rapid treatment after a stroke (within 2-3 hours) can limit permanent brain damage.

D:A:D Study

The D:A:D study is the largest study to look at the risk of heart disease in relation to HIV treatment.

The study collected information from over 20,000 patients from Europe, the US and Israel.

This diversity of patients is one of the study’s strengths. D:A:D found that duration of HIV treatment was related to a small but significant increased risk of heart disease. This was found in different countries and in both men and women.

Relative rate and actual risk

The D:A:D study showed that the relative rate for heart disease increased by around 16% for each year of HIV treatment.

Whether this makes a real difference to your individual risk though depends on whether you are at a high or low risk to start with. Individualising HIV care will be linked to your other risk factors.

If you have high blood cholesterol for example but no other risk factors, then it is less urgent to reduce these levels. However, for a 50-year old male smoker who has high cholesterol and is on HIV medication, it is more important to change one or more of these factors.

How to make lifestyle changes

Changing the risk factors for heart disease can have a direct impact on future risk. By implication, this will also make HIV drugs safer to use.

The advice given to the general population is even more important if you are using HIV treatment.

The most recent research suggests trying a range of products over the first week or two to cope with nicotine withdrawal such as patches, gum, inhalers and sprays so that you find the ones that work best for you.

Your HIV doctor should be able to refer you to specialist services to help you quit.

Any change in level of activity will probably have to start gradually. People who start an exercise programme report benefits in quality of life. This can include increased well-being and energy levels.