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Long-term HIV treatment may reduce risk for atherosclerosis
August 05, 2008Antiretroviral drugs for HIV do not increase the risk for coronary atherosclerosis, a central risk factor for heart disease, according to a study led by the University of Pittsburgh Graduate School of Public Health to be published in the Aug. 8 issue of the journal AIDS and available online today. The results further suggest that antiretroviral therapy may offer men with HIV some protection against atherosclerosis - hardening of the arteries, caused in part by high levels of cholesterol, smoking and other lifestyle factors.
The study, part of the Multicenter AIDS Cohort Study (MACS) initiated in 1983, measured levels of coronary artery calcification (CAC) in nearly 950 HIV-positive and HIV-negative men by CT scanning completed between 2004 and 2006. Controlling for traditional atherosclerosis risk factors such as age, family history, smoking and blood pressure, the study team found that CAC scores were almost 60 percent lower in HIV-positive men who received highly active antiretroviral therapy (HAART) for more than eight years compared to HIV-negative men.
HAART, a course of treatment that involves the combination of three or more antiretrovirals, has been associated with an increase in cholesterol and other factors associated with atherosclerosis, leading some to question whether long-term use increases the risk of heart attack.
"When we first prescribed highly active antiretroviral therapy for HIV in 1995, we were concerned about how these drugs changed lipid levels in patients and whether they would increase atherosclerosis and ultimately lead to serious heart disease," said Lawrence Kingsley, Ph.D., study lead author and associate professor, Departments of Infectious Diseases and Microbiology and Epidemiology, University of Pittsburgh Graduate School of Public Health. "While some studies have found an association between these antiretroviral treatments and increased risk of cardiovascular disease, we believe our findings should reassure clinicians that using antiretroviral therapy over time does not appear to put patients at greater risk for coronary atherosclerosis and may, in fact, be more beneficial than we had initially thought."
The study also found that for both HIV-positive and HIV-negative men, older age was most strongly associated with the presence of coronary atherosclerosis. Smoking, lipid abnormalities and family history also played a role.
"This was not surprising since these are the major risk factors for atherosclerosis in the general population," said Dr. Kingsley. "The purpose of our study, however, was to investigate whether long-term HAART usage was a major risk factor."
"These results could be due, in part, to lower lipid values of HIV infected men prior to beginning antiretroviral therapy and high use of lipid-lowering drugs. The key is that controlling risk factors for atherosclerosis should be a priority," added Lewis Kuller, M.D., Dr.P.H, study co-author and professor of epidemiology, University of Pittsburgh Graduate School of Public Health.
Dr. Kingsley concluded, "What remains to be determined is whether use of the newest antiretroviral therapies confers an even better outcome and whether lipid-lowering therapies will further improve cardiovascular risk in the HIV-infected population. Our future research will address these questions."
University of Pittsburgh Schools of the Health Sciences
"When we first prescribed highly active antiretroviral therapy for HIV in 1995, we were concerned about how these drugs changed lipid levels in patients and whether they would increase atherosclerosis and ultimately lead to serious heart disease," said Lawrence Kingsley, Ph.D., study lead author and associate professor, Departments of Infectious Diseases and Microbiology and Epidemiology, University of Pittsburgh Graduate School of Public Health. "While some studies have found an association between these antiretroviral treatments and increased risk of cardiovascular disease, we believe our findings should reassure clinicians that using antiretroviral therapy over time does not appear to put patients at greater risk for coronary atherosclerosis and may, in fact, be more beneficial than we had initially thought."
The study also found that for both HIV-positive and HIV-negative men, older age was most strongly associated with the presence of coronary atherosclerosis. Smoking, lipid abnormalities and family history also played a role.
"This was not surprising since these are the major risk factors for atherosclerosis in the general population," said Dr. Kingsley. "The purpose of our study, however, was to investigate whether long-term HAART usage was a major risk factor."
"These results could be due, in part, to lower lipid values of HIV infected men prior to beginning antiretroviral therapy and high use of lipid-lowering drugs. The key is that controlling risk factors for atherosclerosis should be a priority," added Lewis Kuller, M.D., Dr.P.H, study co-author and professor of epidemiology, University of Pittsburgh Graduate School of Public Health.
Dr. Kingsley concluded, "What remains to be determined is whether use of the newest antiretroviral therapies confers an even better outcome and whether lipid-lowering therapies will further improve cardiovascular risk in the HIV-infected population. Our future research will address these questions."
University of Pittsburgh Schools of the Health Sciences
Atherosclerosis Current Events and Atherosclerosis News RSSVitamin B niacin offers no extra benefit to statin therapy in seniors already diagnosed with CAD
The routine prescription of extended-release niacin, a B vitamin (1,500 milligrams daily), in combination with traditional cholesterol-lowering therapy offers no extra benefit in correcting arterial narrowing and diminishing plaque buildup in seniors who already have coronary artery disease, a new vascular imaging study from Johns Hopkins experts shows.
Early end to key study on benefits of niacin, a B vitamin, in keeping arteries open was premature
Heart experts at Johns Hopkins are calling premature the early halt of a study by researchers at Walter Reed Army Medical Center and Washington Hospital Center on the benefits of combining extended-release niacin, a B vitamin, with cholesterol-lowering statin medications to prevent blood vessel narrowing.
Can charcoal fight heart disease in kidney patients?
Charcoal may provide a new approach to managing the high rate of heart disease in patients with advanced kidney disease, according to preliminary research being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, CA.
Experts unveil new CVD guidelines and position papers
Several new guidelines and position papers offering the most up to date information to ensure that clinicians practice evidence-based medicine were released at the Canadian Cardiovascular Congress 2009 this week.
Canadian scientists link fat hormone to death from potentially deadly blood infection
A new Canadian study has found that lower-than-normal levels of a naturally-occurring fat hormone may increase the risk of death from sepsis-an overwhelming infection of the blood which claims thousands of lives each year.
Healthy neighborhoods may be associated with lower diabetes risk
Individuals living in neighborhoods conducive to physical activity and providing access to healthy foods may have a lower risk of developing type 2 diabetes in a five-year period, according to a report in the October 12 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Liver cells grown from patients' skin cells
Scientists at The Medical College of Wisconsin in Milwaukee have successfully produced liver cells from patients' skin cells opening the possibility of treating a wide range of diseases that affect liver function.
National report shines light on lupus 50-year treatment drought
Today, The Lewin Group, a national health care consulting firm, issued recommendations on ways to overcome the barriers that have obstructed lupus drug development resulting in no new drug approval for this disease in more than 50 years - since the Eisenhower Administration.
Calcium scans may be effective screening tool for heart disease
A simple, non-invasive test appears to be an effective screening tool for identifying patients with silent heart disease who are at risk for a heart attack or sudden death.
Despite size, NFL players not more likely to develop heart disease, even after retirement
Former professional football players with large bodies don't appear to have the same risk factors for heart disease as their non-athletic counterparts, UT Southwestern Medical Center researchers have found in studying a group of National Football League (NFL) alumni.
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