May 17, 2012
Study Raises Sudden Cardiac Death Concerns in People With HIV
by Tim Horn
Sudden cardiac death—when death occurs within a very short period of time after the onset of heart attack symptoms—accounted for most of the cardiac and non-AIDS natural deaths seen in a chart review of people living with HIV receiving care at San Francisco General Hospital (SFGH), according to a new report published May 15 in the Journal of the American College of Cardiology.
The study also noted that the risk of sudden cardiac death among people living with HIV was 4.5 times the rate in San Francisco’s general population—a finding that has made media headlines. It is important to note, however, that the study was retrospective in design, specific to one city and didn’t include an HIV-negative control group, thus it is difficult to draw firm conclusions regarding the relative and absolute increases in the risk of sudden cardiac death among people living with HIV.
Led by Zian Tseng, MD, an associate professor of medicine in the University of California at San Francisco’s Department of Cardiology, a team of researchers sifted through the medical records—including death certificates and paramedic reports, and interviews with family members, doctors and other clinicians—of 2,680 people living with HIV who received care at SFGH between April 2000 and August 2009.
In an accompanying news announcement, Tseng explained he was interested in studying the link between HIV and sudden cardiac death after noticing many cases of people living with the virus dying suddenly. “I wondered if there was some sort of connection here,” he said.
Patients were followed for an average of 3.7 years; 230 deaths were reported in the group. One hundred thirty-one (57 percent) were AIDS related. Thirty (13 percent) of the deaths met the criteria for sudden cardiac death. Twenty-five (11 percent) of the deaths were due to other non-AIDS-related diseases, and 44 (19 percent) were due to drug overdoses, suicides or unknown causes.
Of the 35 cardiac-related deaths in the group, 30 (86 percent) met the criteria for sudden cardiac death.
Based on the sudden cardiac death rates in the general San Francisco population—using general health statistics, not the medical records of a well-matched HIV-negative control group in the study—Tseng and his colleagues calculated that there should have only been 6.73 sudden cardiac deaths in their HIV medical chart reviews. This translated into a 4.46-fold increase in the risk of sudden cardiac death.
SFGH patients who died of sudden cardiac death tended to be somewhat older (49 versus 45) than those who died of AIDS, have higher CD4 counts (312 versus 87 cells) and have lower viral loads (6,300 versus 63,000 copies). These findings, the researchers argue, indicate that people living with HIV are at risk for sudden cardiac death even in the setting of relatively mild HIV disease.
Still, a number of risk factors were documented by the researchers. Compared with those who died of AIDS during the follow-up period, those who experienced sudden cardiac death were more likely to have had a previous heart attack (17 versus 1 percent), enlargement of the heart (cardiomyopathy; 23 versus 3 percent), congestive heart failure (30 versus 9 percent) and abnormal heart rhythm (arrhythmia; 20 versus 3 percent).
“Given that cardiac symptoms were common in victims of [sudden cardiac death], aggressive primary prevention of [cardiovascular disease] should be considered in HIV-infected patients, especially those with traditional risk factors,” Tseng and his colleagues conclude. “As we seek to reduce mortality in an aging HIV-infected population, greater attention must be directed to the mechanisms underlying [sudden cardiac death], with the goal of identifying at-risk patients and ultimately preventing sudden death.”
Search: sudden cardiac death, scd, cardiovascular, heart, mortality, san francisco, tseng, sfgh
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comments 1 - 7 (of 7 total)
Michelle, , 2012-09-10 11:28:39
So scarey , I'm 51 and I have been going back and for the to the ER due to irregular heart beat , cheat pain , neck pain. I am on Norvir, Prezista , Truvada. I keep bring this to the attention of my doctors and they minimize it. I wish I could stop taking my meds. We need to get to the.bottom of the cause of this heart issue. I'm scared!
June, houston, 2012-05-30 11:12:59
I take isentress and truvada and i am 23 as of this Friday. I've been having horrible chest pain at times that last for days. I just shrugged it off as heart burn. I try to keep in my that i am undetectable and have a reasonable white blood cell count. I am starting to get nervous because it seems to come as i do certain activities like exercising, and even laughing. Also I've been losing my short term memory really badly.
Misa, San Francisco, 2012-05-24 15:45:58
I would love to say it's just a price with having this virus and being on these drugs. But the FDA and our poz community should be very concern! I've been living with this illness for over 23yrs., So, Norvir attacks the heart and Viread attacks the kidneys. Thus, we are to be comfortable with low viral loads and high immune systems and be on dialysis and stents? How about quality of life? is it really better? This is not comfortable to me and now will have a conversation with my doctor about the
Thom, USA, 2012-05-23 22:21:55
Well I am at a double risk, then my grandfather died at 54 heart attack, my father died at 72 heart attack, me, Well, I would like to get a MRI to see if a Stent early might prolong my life, but medicare will not approve the MRI they say I am too young to have a problem I guess nothing is perfect these days.
fraser, athens, al., 2012-05-23 16:36:39
I have been treated for HIV since 1996, 16 years & 2 years ago in June I suffered a Heart attack. Though it IS in my family history, I am taking Norvir , which has serious cardio-vascular side effects & I would LOVE for the FDA to take this drug OFF the market. I've seen MANY friends die from massive heart attacks while taking this drug.
Andy, , 2012-05-23 11:50:14
HIV POS people were dying suddenly over five years ago. The vast majority of people on meds have high blood pressure, high colesterol and triglicerides. Its taken this long for this to be recognized?!? Not much forrecognizing the obvious are they? They need to get stem cell therapy out now!!
Bilou, Salt Lake City, 2012-05-22 11:20:19
comments 1 - 7 (of 7 total)
Five years ago I had to have emergency bypass surgery due to the presence of a "widowmaker," in my left main coronary artery. I was virologically surpressed with a high CD4 counts. My lipid and cholesterol, while a bit high, did not call for a Statin-until the attack. The surgeon commented on the bizzare nature of the lipid deposition which was just restricted to this one area. This was news 5-10 years ago and this study confirms the risk ot pts on HAART who are HIV positive. We need a cure now!
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