November 25, 2009

HIV Heart Disease Risk Might Be Underestimated

Current tools for evaluating an HIV-positive person’s risk of developing cardiovascular disease (CVD) could be underestimating the actual risk, according to a study presented at the European AIDS Clinical Society (EACS) conference in Cologne, and reported by aidsmap.

Numerous studies have documented that people with HIV appear to be at an increased risk for developing CVD—which can lead to heart attacks and strokes. The standard guidelines for assessing a person’s risk for developing CVD include the European Society for Hypertension Guidelines (ESH) and, in the United States, the Framingham Risk Score (FRS).

To determine the accuracy of those risk assessment tools, Giovanni Guaraldi, MD, from the University of Modena in Italy, and his colleagues studied a group of patients in their clinic. Guaraldi’s team evaluated 724 people with HIV, 72 percent of whom were male. The average age was 47.

The team found that 41 percent of the study participants would qualify for therapies, such as statin drugs, to prevent the development of CVD. Researchers used direct electron-beam tomography, also known as a CAT scan, to assess all participants for hardening of the arteries and the accumulation of calcium.

If Guaraldi and his colleagues would have used only the ESH or FRS assessment tools, just 33 and 35 percent of the participants, respectively, would have qualified for CVD preventive treatment. This was particularly troubling in regards to assessing the degree of CVD risk.

Based on the FRS scoring, 71 percent of the participants would have been classified as at low risk, 22 percent at moderate risk and 7 percent at high risk of CVD. Based on the CAT scan, however, 66 percent would be classified as low risk, 24 percent as moderate risk and 10 percent as high risk.

Also, the differences in assessed risk were particularly pronounced in patients younger than 55 and in women.

Though Guaralsi is not suggesting that CAT scans become routine tests, he is recommending that the technology be further studied to verify the degree to which standard measures are underestimating CVD risk.

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William Ross Sumpton, Toronto, 2009-11-28 23:20:15
I went on meds 2and1/2 years ago. I was healthy and remained so with 120/80 blood pressure, below normal colesteral. I am thin, eat well and had a heart attack and by pass surgery 2 months ago. It was a total surprise and my family GP said I was on the bottom of his list as a potential heart victim. The drugs??