Cardiovascular disease (CVD) refers to a group of diseases and illnesses of the heart and blood vessels and includes:
- coronary artery disease (narrowing of the arteries that supply blood to the heart, which can lead to chest pain [angina] or heart attacks)
- cerebrovascular disease (strokes and other problems with blood vessels in the brain)
- hypertension (high blood pressure)
- peripheral vascular disease (blocked blood vessels in the legs).
Changes in blood lipids (fats) are associated with both HIV infection and ARV treatments and with increased risk of cardiovascular disease. Both HIV infection and ARV treatment can change the cholesterol levels in your blood and increase the risk of cardiovascular disease.
Low density lipoprotein (LDL) is also known as bad cholesterol because it can add to the build up of plaque in your arteries and increase your risk of getting coronary heart disease.
High density lipoprotein (HDL) is also known as good cholesterol because it helps to protect you against coronary heart disease.
As people with HIV live longer, cardiovascular disease is becoming an increasingly significant problem for people with HIV. It is now perhaps one of the most common causes of death for people with HIV.
The original goal of HIV management was to target the HIV virus itself, and thus reduce HIV viral load to undetectable levels. However, as awareness of the increasing problem of cardiovascular disease has grown, many doctors now describe an important secondary goal in HIV management is to try to reduce the risk of cardiovascular disease in people with HIV.
There are many risk factors for cardiovascular disease.
- smoking (tobacco and marijuana)
- excessive alcohol consumption
- amphetamine use
- high blood pressure
- poor diet
- insufficient physical activity
- obesity and abdominal fat accumulation (as measured by waist circumference and your BMI [body mass index])
- blood lipid abnormalities, for example,
- high total cholesterol (> 5.2 mmol/L)
- high LDL (>4 mmol/L)
- low HDL (<1.0 mmol/L)
- high triglycerides (> 2.0 mmol/L)
- impaired glucose metabolism
- insulin resistance
- diabetes (fasting glucose >7 mmol/L).
The risk factors identified above however are ones that you can change through appropriate treatment or by making lifestyle changes.
However, risk factors that you can’t change include:
- older age (>45 for males and >55 for females)
- male gender (women tend to lose any protection from CVD once they become post-menopausal)
- being HIV positive
- family history of CVD.
Some ARV treatments are associated with changes to blood lipids (fats) and some of the older HIV drugs increased the risk of diabetes—both of which increase the risk of cardiovascular disease.
Studies show that HIV measurably adds to cardiovascular risk if you also have other risk factors present, but without these other risk factors being present the impact of HIV on increased risk is far less noticeable.
This is why increasing attention in the care and treatment of all people with HIV also focuses on preventing cardiovascular disease.