Managing Cardiovascular Risk in People Living with HIV

J. M. Trevillyan, J. F. Hoy

Research output: Contribution to journalArticleResearch

Abstract

People living with HIV (PLHIV) are at increased risk for cardiovascular disease (CVD) due to bi-directional interactions between traditional cardiovascular risk factors, HIV-associated inflammation and immune activation, and the prothrombotic and dyslipidemic side effects of antiretroviral therapy (ART). As in the general population, prevention of disease is the key to reducing the significant morbidity and mortality associated with cardiovascular disease. All PLHIV should be screened for cardiovascular risk factors such as hypertension and dyslipidemia. Regardless of their perceived level of risk, all individuals should receive counseling on healthy diet habits, exercise, and smoking cessation. Statins should be considered in any HIV-positive individual who has a history of cardiovascular disease or known diabetes and also in those who are at high risk for developing cardiovascular disease due to elevated lipid levels, cigarette smoking status, or blood pressure. Second-line lipid-lowering agents, such as ezetimibe, fibrates, and omega-3 supplementation, can be considered in patients with persisting dyslipidemia despite statin therapy or in whom statins are contraindicated. Monitoring and management of hypertension is also important and can lead to significant reductions in cardiovascular event rates. A combination of angiotensin-converting enzyme inhibition and thiazide diuretic is most likely to successfully lead to reductions in blood pressure and has minimal drug interactions with ART.
Original languageEnglish
Pages (from-to)139-151
Number of pages13
JournalCurrent Treatment Options in Infectious Diseases
Volume8
Issue number2
DOIs
Publication statusPublished - Jun 2016
Externally publishedYes

Keywords

  • HIV
  • Cardiovascular disease
  • Co-morbidities
  • Hypertension
  • Smoking
  • Diabetes
  • Hypercholesterolemia
  • Family history
  • Statins
  • Antihypertensives
  • Antiplatelets
  • Dietary modification
  • Fish oils
  • Smoking cessation

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