People Living With HIV Face Higher Odds for Heart Failure

People with HIV have an added risk of heart failure, so they and their health care providers need to be alert for early signs such as shortness of breath, fatigue, leg swelling, coughing and chest pain, according to a new study.

Even HIV patients who keep their viral load low with antiretroviral therapy (ART) and don’t have anything that makes them more prone to heart disease, such as diabetes have a 1.5 to 2 times higher chance of heart attack or stroke.

"Cardiovascular disease has been an important concern for people with HIV for many, many years," senior author Michael Silverberg said in a Kaiser Permanente news release. He's a research scientist and HIV epidemiologist at Kaiser's Division of Research in Oakland, Calif.

While most of the research has focused on the risk of stroke and heart attacks, this study shows that the heart impacts for people with HIV extend to end-stage conditions such as heart failure, Silverberg says.

The study included nearly 39,000 Kaiser patients with HIV and about 10 times that number without HIV. Those with HIV were 68% more likely to develop heart failure, and the highest risk was among people 40 or younger, women and Asian/Pacific Islanders, researchers found.

"In terms of young people, it's possible that they had fewer other complicating health issues, which made heart failure stand out," says first author Dr. Alan Go, a senior research scientist at Kaiser.

Why are HIV patients at higher risk for heart disease?

He notes that early data suggest HIV may have a greater impact on heart function in women than in men, due in part to hormones and an abnormal thickening and scarring of heart tissue known as cardiac fibrosis. But, Go adds, more study is needed.

"And, overall, not a lot is known about cardiac issues and HIV among Asians and Pacific Islanders," he said in the release.

The study accounted for heart disease risk factors and medications to prevent heart problems, researchers said.

"Our study showed that the higher risk wasn't due to differences in access to care," Go shares. "They were all getting the highest-quality care."

The study also found that the added risk among people with HIV wasn't because they had more heart disease risk factors or had more heart attacks. In fact, people with HIV had fewer heart disease risk factors than those without HIV, the study found.

"The immune system responds to any infection. In a chronic viral infection like HIV, it's thought that in the course of keeping HIV under control, there could be some off-target effects," says Dr. Judith Currier, chief of the infectious diseases division at the University of California, Los Angeles's David Geffen School of Medicine.

"In other words, the immune system is activated to control HIV and in the process of that activation, it could be increasing the risk for heart disease," Currier adds. Chronic inflammation is linked to the buildup of fatty plaque in the arteries, a risk factor for heart disease, according to the American Heart Association.

The authors said their findings show the need to monitor people with HIV for early signs of heart disease.

"HIV patients often receive all of their care in busy HIV primary care clinics, and it is possible that signs and symptoms of heart failure may be missed, resulting in delays in treatment," Silverberg notes.

He added that there's a need to learn more so doctors can intervene earlier.

Preventing heart disease

The first step to preventing heart disease to talk to your doctor about your health history as well as any drugs and medications you are taking (including supplements and recreational drugs). This is important because HIV treatment can complicate the treatment of things that raise your risk of heart attack or stroke.

From there, you can do the following things to lower, your risk of developing heart disease:

Exercise: Regular exercise can lower your blood pressure, cholesterol levels, and body weight.
Don’t smoke: Smoking is one of the biggest causes of heart disease, so if you smoke, quit.
Abstain from alcohol: If must have a drink, it's best to keep it to no more than a drink a day for women, two for men.
Maintain a healthy weight: If you’re carrying too many or too few pounds, consult with your doctor about what a healthy weight is and the best way to reach it.
Eat a healthy, well-balanced diet: Getting an adequate amount of nutrients helps your body fight disease and keeps you at a healthy weight.

By Jessica Daniels, BDO Staff Writer | Published January 13, 2022