Dear Dr Louise: When I was diagnosed HIV-positive in 1993, I never thought I would live to be an old man. Yet here I am! However, I understand heart disease is a problem for people with HIV as they age. Am I at risk? — Brian, Wagga Wagga.
Dear Brian: Thank you for your query. Heart disease is indeed a bigger risk for people with HIV than the general population. Now that people living with HIV (PLHIV) are living longer, the goal of healthcare providers is to encourage PLHIV to stay healthy as they age and adopt a holistic approach to living longer with HIV. Untreated HIV has been associated with heart disease and it is recommended that people with HIV commence treatment earlier to reduce overall cardiovascular risk.
There are a number of immediate lifestyle changes you can adopt to improve heart health. Firstly, if you smoke, stop. New research suggests that cigarette smokers who are HIV-positive appear to have a higher chance of dying from smoking-related complications (such as heart disease and stroke) than from HIV. Indeed, tobacco is the leading killer among positive smokers on antiretroviral treatment.
Second, exercise — particularly cardio exercise such as running, swimming and cycling. Ideally, you need to be moving fast enough to increase your heart rate. Strength training is also good for the heart; try yoga or weights. Aim for at least 30 minutes of moderate-intensity activity five days a week. Stress can increase blood pressure and raise stress hormones, if you’re feeling under mental pressure consider meditation or mindfulness exercises.
Next up is diet. Eat a variety of fruits and vegetables — the wider the colour spectrum the better. A common risk factor for heart disease is having unhealthy levels of blood fats — lipids, such as cholesterol and triglycerides. Eat plant-based fats (such as nuts) as opposed to animal fats (butter, cheese etc). Reducing the intake of process food is advisable as they often contain hidden sugar and salt. Eating healthy and exercising regularly will help control your blood pressure.
However, there are some risk factors you can’t control such as gender and age (men are generally at higher risk of heart disease than women — and from an earlier age). There is also a genetic risk. If there is a history of heart disease in your family, the more likely you will be at risk too.
To recap, many factors contribute to heart disease — some more serious than others. Smoking substantially raises the risk of heart disease. Piling on the pounds also might increase the risk. But the good news is with behavioural changes, alongside regular monitoring, the risk of heart disease can be substantially lowered.
- Dr Louise Owen has been working as a sexual health physician in the HIV sector for 21 years. Previously a director of the Victorian AIDS Council's centre clinic in Melbourne, Dr Louise is currently the director of the Sexual Health Service Tasmania. Her advice is not meant to replace or refute that given by your own health practioner, who is best placed to deal with your individual medical circumstances.
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