Are HIV Patients at Higher Risk for Cardiovascular Disease than Persons of the Same Age in the General Population?

The increasing incidence of cardiovascular disease (CVD) is a concern for HIV patients, and risk assessment for CVD is now part of the standard of care for HIV infection.

The absolute cardiovascular risk in an individual is determined by multiple factors, and various algorithms may be applied. However, to date, few comparisons have been done between HIV positive patients and persons in the general population of the same age and living in the same area.

In the current study, published in the Scandinavian Journal of Infectious Diseases, researchers hypothesized that the calculated risk of CVD may be increased in HIV patients.

The probability for acute coronary events within 10 years (Framingham Risk Score) and the probability for fatal cardiovascular disease (SCORE algorithm) were assessed in 403 consecutive HIV positive subjects free from overt cardiovascular disease, as well as in 96 age- and gender-matched control subjects drawn from the general population living in the same geographical area.

Results

• The average 10-yer risk for acute coronary events was 7.0% (+/- 5%) in HIV positive subjects and 6.3% (+/- 5%) in the general population control group (P = 0.32).

• The 10-year estimated risk for cardiovascular mortality (SCORE algorithm) was 1.23% (+/- 2.3%) and 0.83% (+/- 0.9%), respectively (P = 0.01).

• The main contributor to the increased CVD risk was the high proportion of smokers, not an increase in cholesterol level.

Conclusion

Based on these results, the study authors noted that a "limited increase" in estimated risk of CVD was found in HIV-infected patients compared to the general population.

In addition, they wrote, "In HIV-infected individuals other factors of less value in the general population and not included in any cardiovascular algorithm might be important."

Finally, the authors concluded, "In our patients, intervention to modify traditional risk factors should be addressed primarily towards modifying smoking habits."

Unit of Infectious Diseases, Angiology and Arteriosclerosis, University of Perugia, Italy.

08/31/07

Reference
G V de Socio, L Martinelli, M Fiorio, and others. Is estimated cardiovascular risk higher in HIV-infected patients than in the general population? Scandinavian Journal of Infectious Diseases 39(9): 805-812. 2007.