HIVers’ blood pressure soared after a big study announced two years ago that HIVers had a 26 percent increased risk of heart disease for every year on HAART. But the actual chance of having a heart attack was tiny (1 in 250), and other studies put it under 1 percent. Moreover, classic risk factors for cardiovascular disease (CVD)—like smoking, being male and over 45, having high cholesterol or a family history of CVD—played more of a role than the meds, researchers concluded. American Academy of HIV Medicine director Howard Grossman, MD, says, “Risk factors for heart disease are the same for HIVers” as for neggies. Your chances depend on genes (can’t change them) and lifestyle (can). Knowing your own particular risk is an important part of choosing your HIV meds. If you’re African American, you may face two and a half times the risk; if you’re a man, your risk is higher than women’s. But Wafaa El-Sadr, MD, of Columbia University, warns, “It is a common misconception that women are protected.”
For HIVers, designing life and treatment plans to keep CVD danger from souring your romance with your heart is the first step. Turn the page for six promises you can make to keep your treasured ticker ticking.
Dear Heart, I’ll pick a combo you can live with.
“For patients who do have other CVD risk factors, the metabolic changes wrought by some HIV drugs markedly increase their risk,” Grossman says. Which meds do what?
- Protease inhibitors (PIs)—especially Norvir, Fortovase and Kaletra—can boost evil LDL cholesterol, triglycerides, blood sugar and insulin resistance (all CVD-linked). But HIVer risk equations vary. Carl Grunfeld, MD, PhD, of the University of California San Francisco, estimates that over 10 years, PIs might cause 1.5 extra CVD case in 100 male HIVers with no additional heart-disease risk factors. Add smoking and mild high blood pressure, and the case load increases to 8.
- Need that PI punch? For ease on lipid levels, Reyataz looks like the best in its class.
- Non-nukes like Viramune and Sustiva can raise good cholesterol (see “Fat Facts" below). Frank van Leth, MD, of Amsterdam’s Academic Medical Center, estimated from one study that ditching a PI for non-nuke Viramune could reduce CVD risk by 15 percent (3 percent for Sustiva).
Dear Heart, I won’t let HIV come between us.
- Overall, HIV researchers and doctors agree: HAART benefits outweigh the increased risk. Despite the lipid-raising problems of some meds, Sam Bozzette, MD, PhD, found that among nearly 37,000 positive veterans, CVD events dropped 10 to 20 percent after PIs and combo therapy arrived on the scene. “Cardio risk should be managed, but not at a cost of forgoing needed HIV treatment,” Bozzette says.
- So take your HAART, but monitor heart signs—including blood pressure and sugar—regularly, especially if you have hypertension or diabetes.
Dear Heart, I’ll take you out to (a healthy) dinner.
- The National Institutes of Health recommend that fat should provide no more than 30 percent of total daily calories and daily cholesterol shouldn’t exceed 300 mg—less if you have cardio risk factors. Being overweight—especially having a “spare tire”—inflates heart woes. More on food: See “What’s the Alternative?,” POZ, April 2000, and “Carb Your Enthusiasm,” August 2004.
Dear Heart, I’ll get up and boogie for you.
- Exercise can lower bad LDL cholesterol and boost good HDL—and it can cut down on heart-hurting stress levels. The American Heart Association (AHA) recommends at least 30 minutes of moderate exercise (walking, gardening, climbing stairs, housework) every day. Vigorous aerobic exercise (running, bicycling, jumping rope—even a bout of hot sex) aids your heart even more. For more, see “Work Your Heart Out,” POZ Special Edition, spring 2004. Move it!
Dear Heart, I’ll give you room to breathe.
- Smoking promotes heart disease, because nicotine narrows blood vessels, working your heart overtime and limiting blood flow.It's No. 1 onthe AHA's list of preventable risk factors—yet HIVers puff at nearly twice the rate of neggies.
- The University of North Carolina’s David Wohl, MD, says, “No intervention—from changing meds or diet to taking any amount of fish oil, garlic or statins—will reduce CVD risk as much as [ditching cigs].” Michael Saag, MD, of the University of Alabama, gave POZ a list of 10 things HIVers can do to prevent heart disease. Nos. 1 through 7: “Stop smoking.” If will power isn’t enough, try nicotine patches or support groups—or ask Doc for a prescription med to help you quit. Believe us, we know it’s hard. For more on kicking butts, see “Heavenly and Hazardous,” October 2003.
Dear Heart, I’ll take whatever it takes to be true to you.
- You can bolster lifestyle and HAART adjustments with either statins (like Pravachol or Lipitor) or fibrates (including Lopid and Tricor), which can drop cholesterol and triglycerides (see below). Glitazones can tackle insulin sensitivity. A two-drug mix called BiDil, said to help some African Americans with CVD, may soon be approved. Though none of these has been studied extensively in HIVers, and some have HIV-med interactions, you and Doc can find one to hold lipids in check.
- Hearts on sleeves—we’ve created this Valentine because we love you and your heart. Now it’s up to you: Take it away, dear hearts.
Your heart’s main job is pumping blood to the other organs, snagging and delivering nutrients. It also accepts oxygen packages that the lungs send via coronary arteries. When built-up cholesterol blocks one of these, the heart muscle can die, prompting chest pain and heart attack.
Blood fats, or lipids, wear many guises
Cholesterol comes from the liver and also lurks in foods such as eggs and meat. There are two kinds:
HDL cholesterol, called good because it helps clear cholesterol from the body.
LDL cholesterol. called bad because it deposits cholesterol in the arteries.
Triglycerides are stored fat—in foods and in your body. Elevated triglycerides are linked to heart-disease risk, especially if your cholesterol is high.