People with HIV at high risk of CVD

Even without a history of dyslipidaemia, hypertension, or diabetes, people with HIV (PWH) suffer from a nearly 30-percent higher risk of cardiovascular disease (CVD), according to a study presented at the 2021 Conference on Retroviruses and Opportunistic Infections (CROI 2021).

In this population, effective control and management of CVD risk factors are all the more important.

The study included 8,285 PWH (mean age, 47 years; 91 percent men) and a comparator group of 170,517 people without HIV (PWoH; mean age, 48 years; 90 percent men). Drawing pertinent data from their electronic health records, the researchers assessed the level of control of the three CVD risk factors according to target values of pertinent clinical measures, such as blood pressure, glycated haemoglobin (HbA1c), and lipid profile parameters.

They found that over a 6-month period, PWH had worse control of triglyceride levels, maintaining levels <150 mg/dL for only 78 percent of person-time, as opposed to 86 percent in PWoH. In contrast, HbA1c was better controlled in PWH, in whom levels were <6.5 percent for 73 percent of person-time, compared to 65 percent in PWoH. [CROI 2021, oral abstract 97]

Disease control was quantified using the Disease Management Index, which takes into account how much time a specific clinical measure was out of control and by how much. Clinical measures are expressed as percentiles and compared against a reference treated population.

The researchers then assessed the CVD risk among PWH according to the level of risk factor control. They found that CVD was almost 30-percent more likely to develop among PWH without history of hypertension, dyslipidaemia, or diabetes (hazard ratio [HR], 1.26).

A similar effect was found when stratifying according to hypertension control. Even among PWH with adequate hypertension control, CVD risk was significantly higher by 35 percent (HR, 1.35). Those with inadequate control (80-percent control of diastolic blood pressure) were nearly twice as likely to develop CVD (HR, 1.91).

In contrast, dyslipidaemia and diabetes seemed to be less influential in PWH, such that adequate levels of control correlated with no excess CVD risk.

“Effective management of dyslipidaemia and diabetes can help reduce the CVD burden in PWH,” the researchers said. However, that CVD risk appears to be elevated among hypertensive PWH, as well as in those without clear risk factor histories, are concerning.

The present study included a large cohort of PWH and a well-matched comparator group. The measurement of CVD risk factors and the determination of HIV status and CVD outcomes were conducted comprehensively and to a high degree of confidence. This indicates that the present findings are highly generalizable to the broader population of insured PWH.

Nevertheless, the study sample was predominantly male, suggesting that results may not be as readily applicable to women with HIV. Additionally, important potential confounders, such as participant diet and exercise, were unmeasured and unaccounted for. Subsequent efforts are needed to address these limitations.

“Future research needed to assess whether more aggressive targets are warranted for PWH,” the researchers said.