The risk of heart attack and stroke among patients with HIV was predicted to be nearly double that of the general population, a new study published in JAMA Cardiology has found. 

Study authors from Northwestern University Feinberg School of Medicine further reported that the higher risk for heart attack (1.5–2 times greater), was even seen in patients whose virus was undetectable due to antiretroviral treatment. Understanding a patient’s risk can help determine whether he or she should receive medications such as statins to decrease the risk of heart attack or stroke. 

Researchers conducted the study using a large, multicenter clinical cohort of approximately 20,000 individuals infected with HIV receiving treatment at one of five participating sites around the country. They compared predicted rates of heart attacks based on data from the general population vs. the HIV cohort. 

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Chronic inflammation and viral replication seen in HIV patients is thought to cause plaque buildup which can lead to a heart attack or a stroke. Even for patients with undetectable virus in the blood, there is still virus lingering in the body’s tissues creating inflammation. This buildup happens 10–15 years sooner in HIV patients compared to non-HIV patients. 

The study’s first author, Dr. Matthew Feinstein, explained, “It’s this inflammatory state that seems to drive this accelerated aging and these higher risks for heart disease, which are becoming more common in HIV patients as they live longer.” Traditional risk factors such as smoking were also attributed to increased heart attack and stroke rates. 

No matter the individual’s age, gender, or race, the risks were greater in patients with HIV. For HIV-infected groups, the current tool used for predicting heart attack (based on heart attack risk for >200,000 patients in the general population) proved most effective for Caucasian men but least accurate for African-American men and women. 

“A new predictive algorithm may need to be developed to determine the actual risk for heart attack and stroke in people with HIV,” concluded Dr. Feinstein. Additional research is needed to improve HIV risk assessment, he concluded. 

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