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IDSA 2011: Heart Problems Are Common Among People with HIV, but Largely Related to Modifiable Risk Factors

Structural and functional cardiac abnormalities were found in more than half of an HIV positive cohort in Washington, DC, according to a report at the 49th Annual Meeting of the Infectious Diseases Society of America (IDSA 2011) last month in Boston. Heart problems were often related to modifiable factors such as obesity and diabetes, suggesting that lifestyle changes may lower the risk.alt

Several observational studies have shown a higher rate of cardiovascular events such as heart attacks in people with HIV, though it is not yet clear whether this is due to chronic HIV infection itself, resulting immune activation and inflammation, side effects of antiretroviral drugs, traditional risk factors, or a combination of these factors. HIV positive people also may be at increased for subclinical cardiac abnormalities, or those that do not yet cause overt symptoms.

Samad Rasul from Howard University Hospital and colleagues performed a retrospective, cross-sectional analysis to characterize structural and functional echocardiogram (ultrasound) findings for HIV positive patients seen at their inner-city teaching hospital.

This analysis included data from 113 consecutively selected patients who received an echocardiogram between March 2009 and March 2011. Echocardiograms were done in different settings including ambulatory clinics, inpatient hospital wards, and critical care units.

Approximately half of participants were men and half were women. All were black/African-American, and the average age was about 48 years; 57% were on combination antiretroviral therapy (ART), but the median CD4 T-cell count was just 129 cells/mm3. The most common reason for getting an echocardiogram was shortness of breath, but people diagnosed with or being evaluated for an active cardiac condition were excluded

Results

  • Overall, the following abnormalities were observed:
    • 59.3% of patients had elevated pulmonary artery pressure;
    • 37.2% had increased left ventricle wall thickness;
    • 25.7% had left atrium enlargement;
    • 23.0% had low (<55%) left ventricle ejection fraction;
    • 12.4% had pericardial effusion;
    • 8.9% had diastolic dysfunction.
  • Factors significantly associated with low left ventricle ejection fraction were a history of coronary artery disease, prior heart failure, abnormal blood lipid levels (dyslipidemia), and chronic kidney disease.
  • Body mass index (BMI) > 30 -- the threshold for obesity -- was a significant risk factor for diastolic dysfunction.
  • Significant risk factors for left atrium enlargement were BMI > 30 and diabetes.
  • No significant differences in cardiac abnormalities wereobserved between patients on ART versus those not on ART.

"The prevalence of structural and functional cardiac abnormalities was noted to be high," the investigators concluded. "Modifiable cardiac risk factors were significantly associated...with these findings."

"CD4+ T-cell count, viral load, and individual [ART] regimen were not noted to contribute significantly to echocardiographic abnormalities," they continued. "As HIV-infected patients are living longer in the era of [ART], our findings reinforce the need for aggressive management of modifiable cardiac risk factors."

While prior medical history cannot be changed, obesity and blood fat levels are modifiable with changes such as improved diet, increased exercise, and lipid-lowering medications.

Investigator affiliations: Div. of Infectious Diseases, Dept. of Internal Medicine, Howard University Hospital, Washington, DC.

11/1/11

Reference

S Rasul, S Ramsahai, R Chintala, et al. Prevalence and Patterns of Echocardiographic Abnormalities in HIV-Infected, Black Individuals in an Inner City Teaching Hospital in Washington, DC. 49th Annual Meeting of the Infectious Diseases Society of America (IDSA 2011). Boston, October 20-23, 2011. Abstract 434.