Are People With Hiv At Risk For Heart Disease
Yes. The risk factors for heart disease are the same for people with HIV and people without HIV. However, HIV and some HIV medicines may increase the risk of heart disease in people with HIV.
Research is underway to understand the connection between HIV and heart disease. Go to ClinicalTrials.gov to find HIV research studies related to heart disease. For help with your search, call a Clinical Info health information specialist at 1-800-448-0440 or email .
How Can My Risk For Cvd Be Monitored
Your doctor and, in some cases, nurse can request different tests to help assess your risk for CVD. Here is a list of some of the more common tests :
Cholesterol and triglyceride levels
Getting your blood tested regularly for cholesterol and triglyceride levels is an important way for many people to keep track of a major risk for CVD. Ideally, blood should be drawn after you have fasted for 12 consecutive hours, so it is best done in the morning after you have not had anything to eat the night before. Also, avoid alcohol for two consecutive days before having your blood tested. Keeping your levels of so-called bad cholesterol low helps reduce your risk for a heart attack and other related problems. And keeping your levels of so-called good cholesterol high is also a good idea. There are a group of prescription medicines called statins . They are highly effective at reducing abnormal cholesterol levels and are used as part of a plan to help reduce your risk for cardiovascular disease. Depending on your age and CVD risk factors, your doctor may prescribe a statin.
Blood sugar levels
Blood pressure
A technician puts small sensors on your chest. These sensors can detect the electrical signals that your heart produces every time it beats. The ECG records these electrical signals and produces a chart commonly called a cardiogram. Your doctor can inspect the chart to find out if your heart is beating abnormally.
Holter monitoring
Echocardiogram
Chest x-ray
Cardiac CT scan
Looking After Your Heart
Everybody can help keep their heart healthy by eating a healthy, balanced diet. This includes having at least five helpings of fruit and vegetables a day, and reducing saturated fats, salt and sugar. Smoking, drinking excessively , and recreational drug use can all damage the heart. Not smoking, or stopping, will make a big difference to your heart health. Keeping your alcohol consumption within the recommended limits and maintaining a healthy weight will help.
risk factor
An aspect of personal behaviour or lifestyle, an environmental exposure, or a personal characteristic that is thought to be associated with an infection or a medical condition.
Doing regular exercise that makes you out of breath and breaks a sweat regularly is important for heart health. There is advice available on the amount of exercise recommended on the NHS Choices website. If you are unused to exercise or have heart problems, it is important to start gently or seek advice from your healthcare team.
Look after any other health conditions such as diabetes and take any prescribed medication at the right time and in the right way. If you think stress is contributing to any risk factors, talk to your GP or staff at your HIV clinic. They will be able to help with advice and referrals to other services if you think that would help.
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Symptoms Of Heart Disease
Tiredness, breathlessness, an unusual heartbeat and chest pains are common symptoms of heart disease. You may not have any symptoms at all before you are diagnosed with heart disease. For some people, the first symptoms are noticed when they have a heart attack. These can include pain or pressure in the chest, pain in the left arm, jaw, back, abdomen or shoulder, sweating, nausea or vomiting, lightheadedness and breathlessness.
If you experience any of these symptoms, it is important that you get medical advice as soon as possible. If you suspect you are having a heart attack, call an ambulance immediately. Sit and rest until the ambulance arrives. Chew an adult aspirin tablet if one is easily available, unless youre allergic to aspirin or youve been told not to take it.
If you experience any of these symptoms, it is important that you get medical advice as soon as possible. If you suspect you are having a heart attack, call an ambulance immediately.
Can Nutritional Supplements Help Prevent Cvd
We previously outlined some general dietary and lifestyle changes that can be helpful when used as part of an overall plan to prevent CVD. From time to time you may hear about natural health products that are supposed to prevent or cure heart disease. Unfortunately, there is no such magic supplement.
Some people, under the supervision and advice of their doctor, dietician and/or naturopath, use certain supplements in addition to lifestyle changes or prescription medicines.
Always let your doctor, nurse and pharmacist know what medicines , herbs and supplements you are taking. This is because some natural health products can weaken the effects of your medications, make pre-existing medication side effects worse or cause their own side effects.
Some supplements that are under study for a possible role in the prevention of CVD include:
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Can We Identify People At Risk
Hsue said that it is difficult for physicians to anticipate when people living with HIV might be vulnerable to cardiac problems. We are not great at predicting people who are going to have a heart attack, she said.
Physicians use risk calculatorsand plug in factors like gender, cholesterol, and smoking historyto estimate cardiac risk among people in the general population. But these calculators dramatically underestimate the risk for people living with HIV. One study, said Hsue, found that risk calculators underestimated the risk of having a heart attack by almost 50%.
The other issue is that researchers and clinicians dont know what the risk of cardiovascular problems are for people who started taking HIV medications soon after their HIV diagnosis.
Can Symptoms Differ For Women
Although men and women can experience the same symptoms of coronary heart disease, women often experience no symptoms or have different symptoms than men do.
- Activity that brings on chest pain. In men, angina tends to worsen with physical activity and go away with rest. Women are more likely than men to have angina while they are resting. In women who have coronary microvascular disease, angina often happens during routine daily activities, such as shopping or cooking, rather than during exercise. Microvascular angina events may last longer and be more painful than other types of angina.
- Location and type of pain. Pain symptoms are different for each person. Women having angina or a heart attack often describe their chest pain as crushing, or they say it feels like pressure, squeezing, or tightness. Women may have pain in the chest or the neck and throat.
- Mental stress. Mental stress is more likely to trigger angina pain in women than in men.
- Other symptoms. Common signs and symptoms for womenincludenausea, vomiting, shortness of breath, abdominal pain, sleep problems, fatigue, and lack of energy.
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Are Cardiovascular Problems Inevitable
I think inevitable is a stronger word than I would choose, said Hsue, responding to audience members who expressed concern at the research shared at the event. Nothing is inevitable. I think the issue now is youre going to do well with HIV. But its more these chronic health conditions, the chronic inflammation, the non-AIDS conditions, like renal disease, lung disease and heart disease which are becoming more and more important.
Its important, she stressed, for people to change the things that are under their controllike quitting smoking. Studies show that people living with HIV lose more years to smoking than HIV disease itself. This is a reminder, to me as a heart doctor, about the importance of counseling all of my patients to stop smoking. But, its incredibly hard for people to do.
Theres still a lot we dont know about cardiovascular risk and inflammation for people living with HIV, said Hsue, underscoring the importance of research that is parsing exactly where risk is coming from, and what we can do to reduce risk.
What Should I Do If I Need Help For A Mental Health Problem
Talk to your health care provider about how you are feeling. Tell them if you are having any problems with drugs or alcohol.
Your health care provider will consider whether any of your HIV medicines may be affecting your mental health. They can also help you find a mental health care provider, such as a psychiatrist or therapist.
Here are additional ways to improve your mental health:
- Join a support group.
- Try meditation, yoga, or deep breathing to relax.
- Get enough sleep, eat healthy meals, and stay physically active.
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Problems Affecting The Blood Vessels
Problems with how the hearts blood vessels work can cause coronary heart disease. For example, the blood vessels may not respond to signals that the heart needs more oxygen-rich blood. Normally, the blood vessels widen to allow more blood flow when a person is physically active or under stress. But if you have coronary heart disease, the size of these blood vessels may not change, or the blood vessels may even narrow.
The cause of these problems is not fully clear. But it may involve:
- Damage or injury to the walls of the arteries or tiny blood vessels from chronic inflammation, high blood pressure, or diabetes.
- Molecular changes that are part of the normal aging process. Molecular changes affect the way genes and proteins are controlled inside cells.
In nonobstructive coronary artery disease, damage to the inner walls of the coronary arteries can cause them to spasm . This is called vasospasm. The spasm causes the arteries to narrow temporarily and blocks blood flow to the heart.
These problems can also happen in the tiny blood vessels in the heart, causing coronary microvascular disease . Coronary microvascular disease can happen with or without obstructive or nonobstructive coronary artery disease.
Learn more about the important role that inflammation, which is the bodys reaction to an injury, plays in the development of coronary heart disease.
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Why Does Coronary Heart Disease Affect Women Differently
Coronary heart disease is different for women than men because of hormonal and anatomical differences.
- Hormonal changes affect a womans risk for coronary heart disease. Before menopause, the hormone estrogen provides women with some protection against coronary artery disease. Estrogen raises levels of HDL cholesterol and helps keep the arteries flexible so they can widen to deliver more oxygen to the tissues of the heart in response to chemical and electrical signals. After menopause, estrogen levels drop, increasing a womans risk for coronary heart disease.
- The size and structure of the heart is different for women and men. A womans heart and blood vessels are smaller, and the muscular walls of womens hearts are thinner.
- Women are more likely to have nonobstructive coronary heart disease or coronary microvascular disease. These types are harder to diagnose than obstructive coronary artery disease, which can be harder to diagnose. This can cause delays in getting diagnosed and treated.
Learn The Warning Signs Of Serious Complications And Have A Plan
Coronary heart disease can lead to heart attack or stroke. If you think that you are or someone else is having the following symptoms, Every minute matters.
Heart attack
The signs and symptoms of a heart attack include:
- Prolonged or severe chest pain or discomfort not relieved by rest or nitroglycerin. This involves uncomfortable pressure, squeezing, fullness, or pain in the center or left side of the chest that can be mild or strong. This pain or discomfort often lasts more than a few minutes or goes away and comes back.
- Nausea, vomiting, light-headedness or fainting, or breaking out in a cold sweat. These symptoms of a heart attack are more common in women.
- Shortness of breath. This may accompany chest discomfort or happen before it.
- Upper body discomfort.This can be felt in one or both arms, the back, neck, jaw, or upper part of the stomach.
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Can Hiv Cause Heart Disease
As we get older, the risk of heart disease increases, regardless of HIV status but if you are living with HIV you may be more likely to develop heart disease compared to someone who does not have HIV. There are a number of reasons for this, including the damage the virus itself causes your body, as well as lifestyle and treatment choices you can make.
The good news is that there are a number of things you can do to manage your risks.
Cardiac Complications Of Aids
Cardiac disease in AIDS patients could be caused by infectious complications of AIDS, AIDS medical therapies, or HIV infection of the myocardium.
The myocardium infection can cause fluid to build up around the heart, or cause congestive heart failure to occur. If the person becomes septic, it can cause low blood pressure.
Some cardiac complications associated with HIV/AID are:
- Pulmonary hypertension
- Heart Failure
- Aids dementia complex
If a person is septic, and they also have HIV / AIDS they can be very ill. Sepsis usually requires admission into the intensive care unit.
During this time, the patient can have low blood pressure because of a blood infection. Often in order for the blood pressure to come back up, the patient will need plenty of fluids.
Sometimes fluids are not enough, and they will need vasopressors to bring up the blood pressure. When a patient gets to this point, they are quite ill and they need critical support.
Patients with AIDS cardiac complications requires the same treatment as other patients who do not have the syndrome.
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Why Should People Living With Hiv Be Concerned About Cvd
In the first two decades of the HIV epidemic the biomedical focus was to prevent and treat life-threatening infections. However, now that effective antiretroviral therapy is widely available in high-income countries, deaths from life-threatening infections are uncommon. As a result, HIV-positive people are living longer. As they get older, people with HIV become vulnerable to all the complications brought on by ageingthis includes CVD.
In addition to this, ongoing HIV infection, particularly if left untreated, can increase the risk of CVD. This happens because the ongoing replication of HIV in your body causes your immune system to be in a continuous state of high-level inflammation. Over the long-term, continuous inflammation releases chemical messengers called cytokines that harm the body, damaging and degrading tissues.
Not only does HIV-related inflammation injure the immune system and other organ-systems, it also accelerates the ageing of blood vessels. The use of ART greatly decreases HIV-related inflammation. Indeed, studies have found that people who stop taking ART have a greatly increased risk for heart attacks and stroke. However, even in the setting of low or undetectable viral load, low-level inflammation triggered by HIV infection may continue to slowly affect organs and blood vessels, but at a much lower level than before. Over the long-term, this inflammation may heighten the risk for CVD in HIV-positive people.
Hiv And Cardiovascular Disease
Cardiovascular disease includes a group of problems related to the heart or to blood vessels CVD includes:
- coronary heart disease
- angina
- cerebrovascular disease
- high blood pressure
- peripheral artery disease
- rheumatic heart disease
- congenital heart disease and
- heart failure.
Worldwide, CVD is the cause of about 30% of all deaths.
WHY SHOULD PEOPLE WITH HIV CARE ABOUT CVD?Because HIV medications are so effective, people with HIV are living longer. Some studies show that CVD is the cause of 20% of deaths of people with HIV.
People with HIV have higher rates of CVD than the general population. HIV infection by itself increases some CVD risk factors. It might also increase CVD in ways we don’t yet understand. Some drugs used in antiretroviral therapy can increase CVD risk. HIV infection causes inflammation, and ART reduces that inflammation. This reduces CVD risk. Stopping ART and letting the viral load rise increases CVD risk.
WHAT CAUSES CVD?Angina is caused by a blockage that creates a shortage of blood to the heart. Heart attacks and strokes are caused when a blockage becomes so severe that the heart or the brain is damaged.
The most common cause is a build-up of fatty deposits on the inner walls of the blood vessels. They become narrower and less flexible. This is known as atherosclerosis . It can cause angina.
Increasing age, being male, and family history of CVD, also increase the risk of CVD.
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