Prevention Strategies for Cardiovascular Disease in HIV-Infected Patients

Stein, James H.; Hadigan, Colleen; Brown, Todd T.; Chadwick, Ellen G.; Feinberg, Judith; Friis-Møller, Nina; Ganesan, Anuradha; Glesby, Marshall J.; Hardy, David; Kaplan, Robert C.; Kim, Peter; Lo, Janet; Martínez, Estebán; Sosman, James M.

doi:10.1161/circulationaha.107.189628

Cited by 44 publications

(55 citation statements)

References 73 publications

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“…6,7 Beside its role as a powerful risk factor in itself, hypertension entails left ventricular (LV) changes, mainly characterized by myocardial hypertrophy and diastolic dysfunction, that are per se independent predictors of cardiovascular events. 8,9 HIV infection and HAART may cause blood pressure (BP) elevation, 7,10 but could play a role in the development of LV remodelling, also independently of BP values. In fact HIV þ patients develop a wide range of metabolic and anthropometric abnormalities, including insulin resistance, diabetes, hypertrygliceridemia and increased abdominal adiposity.…”

Section: Introductionmentioning

confidence: 99%

Left ventricular remodelling in asymptomatic HIV infection on chronic HAART: comparison between hypertensive and normotensive subjects with and without HIV infection

et al. 2011

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The high cardiovascular risk of HIV infected (HIV þ ) patients is still partly unexplained. We aimed to evaluate if HIV infection and highly active antiretroviral therapy (HAART) are linked per se to left ventricular (LV) remodelling, independently of blood pressure (BP) values. We enrolled 4 groups of patients matched by gender, age, body mass index and smoking habit: 30 HIV þ hypertensives, 30 HIV þ normotensives, 30 notinfected (HIVÀ) hypertensives and 30 HIVÀ normotensives. HIV þ patients were on chronic HAART. Hypertension was newly diagnosed (p6 months) and never treated. Each patient underwent blood tests, 24-h BP monitoring and LV echocardiogram. The 4 groups had similar fasting glucose and cholesterol; triglycerides, HOMA index and prevalence of metabolic syndrome were higher in the HIV þ groups. Despite similar 24-h BP values, HIV þ hypertensives had greater LV mass and higher prevalence of preclinical diastolic dysfunction than HIVÀ hypertensives. Compared to HIVÀ normotensives, HIV þ normotensives had similar 24-h BP values, but greater LV mass and lower LV diastolic indices, similar to HIVÀ hypertensives, whose 24-h BP values were higher. Asymptomatic HIV infection and chronic HAART are associated with myocardial hypertrophy and preclinical diastolic dysfunction, independently of BP values.

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Section: Introductionmentioning

confidence: 99%

Left ventricular remodelling in asymptomatic HIV infection on chronic HAART: comparison between hypertensive and normotensive subjects with and without HIV infection

et al. 2011

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“…Currently, obesity is also common among patients with HIV, which represents a change from the early days of this disease, when many patients presented with wasting and cachexia. Obesity is present in >40% of women and >60% of men with HIV [50]. Therefore, encouraging weight loss and aerobic exercise 30–60 min at least 5 times weekly is important; in addition, patients should see a nutritionist when weight loss is not achieved [43].…”

Section: Implications For Prevention Of Stroke In Hiv-infected Patientsmentioning

confidence: 99%

Recent Developments regarding Human Immunodeficiency Virus Infection and Stroke

2012

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Human immunodeficiency virus (HIV) infection is strongly associated with ischemic stroke in the young. Data obtained from the Nationwide Inpatient Sample in the United States show an increase in the number of stroke hospitalizations in the HIV-infected population despite an overall decrease in the number of stroke hospitalizations. Few data exist, however, that address the mechanism of HIV-associated stroke. Recent studies have demonstrated that HIV may infect the endothelium and alter cerebrovascular functions. Whether the proposed mechanism alters the stroke risk is undetermined. Epidemiological studies suggest that HIV-related stroke is associated with a risk factor profile that differs from the HIV-negative young stroke population in that HIV-associated strokes are less likely to have hypertension, diabetes, hyperlipidemia and smoking as risk factors. A large population-based study, moreover, suggests an association between antiretroviral therapy and increased cardio- and cerebrovascular risks. Specific antiretroviral agents such as protease inhibitors and non-nucleoside reverse transcriptase inhibitors have been implicated in the metabolic syndrome, accelerated atherosclerosis and an increased risk for ischemic stroke. In addition to discussing these developments, this paper also discusses the implications of recent data for stroke prevention in HIV-infected patients.

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“…Several factors lead to atherosclerosis in patients with HIV [1][2][3]13]. Dyslipidemia, lipodystrophy, insulin resistance, and inflammation result from a complex interplay between HIV-related and ART-related effects in the background of a high prevalence of traditional risk factors, leading to atherosclerotic disease [1,13].…”

Section: Pathophysiology Of Atherosclerosis In Hivmentioning

confidence: 99%

“…Dyslipidemia, lipodystrophy, insulin resistance, and inflammation result from a complex interplay between HIV-related and ART-related effects in the background of a high prevalence of traditional risk factors, leading to atherosclerotic disease [1,13]. Patients with HIV have an enormous burden and severity of traditional risk factors [13,14]. Cigarette smoking is highly prevalent among patients with HIV (47% to 71%) and is much more prevalent than in the general population [15].…”

Section: Pathophysiology Of Atherosclerosis In Hivmentioning

confidence: 99%

“…Cigarette smoking is highly prevalent among patients with HIV (47% to 71%) and is much more prevalent than in the general population [15]. Aside from having a history of cardiovascular disease (CVD), current cigarette smoking is the most powerful predictor of CVD events among patients with HIV [13,15]. The prevalence of hypertension in patients with HIV ranges from 12% to 20% among individuals less than 40 years of age and from 35% to 41% for individuals ≥40 years of age [16].…”

Section: Pathophysiology Of Atherosclerosis In Hivmentioning

confidence: 99%

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The Spectrum of Atherosclerotic Coronary Artery Disease in HIV Patients

Hakeem

Bhatti

Çilingiroğlu

2010

Curr Atheroscler Rep

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The incidence of HIV is on the rise. With the advent of antiretroviral therapy, the average life expectancy of HIV patients has increased by several decades, but the increasing life expectancy has shifted the spectrum of HIV-associated morbidity and mortality away from opportunistic infections and toward chronic medical conditions. In fact, coronary artery disease has become the leading cause of mortality in patients with HIV. The pathophysiology of atherosclerosis in patients with HIV is very complex, including direct endothelial damage from viremia, a heightened overall state of inflammation from immune activation, higher prevalence and contribution from traditional atherosclerotic risk factors, and direct effects from antiretroviral therapy itself. This review focuses on the patterns, predictors, and pathophysiology of atherosclerotic disease in patients with HIV. In addition, the risks and benefits of evidence-based highly active antiretroviral therapy are critically evaluated.

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Prevention Strategies for Cardiovascular Disease in HIV-Infected Patients

Cited by 44 publications

References 73 publications

Left ventricular remodelling in asymptomatic HIV infection on chronic HAART: comparison between hypertensive and normotensive subjects with and without HIV infection

Left ventricular remodelling in asymptomatic HIV infection on chronic HAART: comparison between hypertensive and normotensive subjects with and without HIV infection

Recent Developments regarding Human Immunodeficiency Virus Infection and Stroke

The Spectrum of Atherosclerotic Coronary Artery Disease in HIV Patients

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