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HIV and Heart HealtH
It’s no secret that both HIV and antiretroviral treatment can cause problems that can increase the risk of cardiovascular disease, including heart attacks and strokes. However,
there are many ways to protect your heart if you’re HIV positive, including selecting
antiretrovirals carefully, monitoring your lipid levels, and doing your best to control classic
risk factors like high blood pressure, diabetes, smoking, diet and stress.
How doeS HIV IncreaSe Heart dISeaSe rISk?
Research shows that HIV meds can increase lipids (fats) in the blood, which can clog
arteries, possibly leading to a heart attack or stroke. Almost all of the protease inhibi-
tors (PIs) have been shown to increase levels of cholesterol and triglycerides, two lip-
ids associated with cardiovascular disease. Lipid increases can also be seen in people taking non-nucleoside reverse transcriptase inhibitors, although usually to a lesser degree. Some nucleoside reverse transcriptase inhibitors may also increase lipids and
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HIV itself has also has been tied to an increased risk of cardiovascular disease. In
one major study, there was a higher risk of cardiovascular disease among HIV-positive
people who weren’t on treatment, compared with those who were taking HIV medica-
tions, including some known to increase lipid levels. While the reason for this isn’t clear,
it could be that untreated HIV infection can lead to inflammation, which can cause
damage to the cardiovascular system.
These research findings suggest that HIV treatment actually plays an important role
in preventing cardiovascular disease. As for the lipid increases caused by antiretrovirals,
a selection of lipid-friendly options is possible, especially for people with a history of
high cholesterol levels. If your levels increase while on treatment, options are available.
more than 40 inches for men and more than 35 inches for
wHat about otHer rISk FactorS?
In addition to treating HIV and watching for lipid increases caused by antiretroviral therapy, it’s important for HIV-positive people to make the same lifestyle changes that
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are recommended for anyone at risk for heart disease.
risk factors that can’t be changed:
The risk of cardiovascular disease increases for
men over 45 and women over 55. Men have a greater risk of heart disease and tend
to have heart attacks earlier in life. And you’re more likely at risk if there’s a history of
cardiovascular disease in your immediate family. Race is also an issue—blacks are more
likely to suffer from high blood pressure than whites, putting them at an increased risk.
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risk factors that can be changed:
■ Smoking cigarettes
is a major risk factor. It not only doubles the risk of a heart attack,
smokers are more likely to die within an hour of a heart attack than nonsmokers.
■ High lipids
might be controlled by switching to a more cholesterol-friendly regimen.
Lipids can also be reduced with diets low in fat. Cholesterol- and triglyceride-reducing meds, such as statins (e.g., Pravachol and Lipitor), bile-acid resins (e.g., Questran and Colestid), nicotinic acid (e.g., niacin) and fibrates (e.g., TriCor and
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■ High blood pressure
, also known as hypertension, greatly increases the risk of
about HIV and
heart disease. Maintaining a healthy weight, exercising, quitting smoking and re-
ducing alcohol consumption can all help.
should also be avoided—or managed correctly—to reduce the risk of
heart disease. Some HIV meds, notably the PIs, can cause insulin resistance, which
can increase the risk of diabetes, especially in people with other risk factors, includ-ing older age, family history, being overweight and physically inactive. Diet and exercise can reduce the risk of diabetes, and meds are available to help manage it.
Exercise and depression Exercise referral and the treatment of mild or moderate depressionInformation for GPs and healthcare practitionersThere is a substantial body of evidence to show a causal link between physical activity and reduced clinically defined depression, and comparative studies have demonstrated that exercise can be as effective as medication or psychotherapy. Trea
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