Risk for MI, Stroke Is Vastly Underestimated in Patients With HIV

Be careful out there.
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Current methods to predict the risk of myocardial infarction (MI) and stroke vastly underestimate the risk in individuals with HIV, which is nearly double that of the general population, according to a study published online by JAMA Cardiology.
“The actual risk of heart attack for people with HIV was roughly 50% higher than predicted by the risk calculator many physicians use for the general population,” said Matthew Feinstein, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
The higher risk for MI -- about 1.5 to 2 times greater -- exists even in people whose virus is undetectable in their blood because of antiretroviral drugs.
Accurately predicting an individual’s risk helps determine whether he or she should take medications such as statins to reduce the risk of MI or stroke.
“If you have a higher risk for heart attack or stroke, your ability to benefit from one of these drugs is greater and justifies the possible side effects of a medication,” said Dr Feinstein said.
A new predictive algorithm may need to be developed to determine the actual risk for MI and stroke in people with HIV, he noted.
The study was conducted using a large, multi-centre clinical cohort of HIV-positive individuals receiving care at 1 of 5 participating sites around the country. The researchers analysed data from approximately 20,000 HIV-positive individuals. They compared predicted rates of MIs based on data from the general population to the actual rates of MIs observed in this cohort.
The primary driver of the higher risk is the HIV, scientists believe.
“There is chronic inflammation and viral replication even in people whose blood tests don't show any sign of the virus in the blood,” explained Dr. Feinstein.
That's because the virus still lurks in the body's tissues, creating the inflammation that causes plaque build-up that can lead to a MI or a stroke. This build-up occurs 10 to 15 years earlier in patients with HIV than in people without HIV.
“It's this inflammatory state that seems to drive this accelerated aging and these higher risks for heart disease, which are becoming more common in HIV patients as they live longer,” said Dr. Feinstein.
The current study builds on previous HIV-related heart disease research by Feinstein, published in November, 2016, which found that individuals with HIV had more scarring in the heart muscle after MIs, indicating an impaired ability to heal their hearts. Reasons for this are unknown but are an area of active study for Feinstein and his colleagues.
A clinical trial is underway at Northwestern Medicine to evaluate how well common medications for heart disease prevention and treatment, such as statin medications, work to prevent heart disease in the HIV-infected population.
SOURCE: Northwestern University