ARE OLDER ADULTS WITH HIV MORE LIKELY TO HAVE HEART DISEASE?
Yes. Apart from the other common causes of heart disease, HIV itself can raise your cholesterol or cause direct heart damage over time. In addition, the chronic activation of the immune system caused by HIV, known as “inflammation”, increases your risk of heart disease even if your viral load is undetectable.
IS THAT SERIOUS?
Heart disease is the number one killer in the United States. It can also cause weakness, pain, or difficulty breathing. Even if heart disease doesn’t kill you, the condition can lessen your ability to be active, work, and enjoy life. Even if your HIV is under control, your risk of heart disease is higher than someone who is HIV negative, so talk to your doctor about what you can do to lower your risk.
What you can do with your doctor
TELL YOUR DOCTOR IF YOU DON’T FEEL WELL
Many symptoms can be signs of heart disease, including chest pain, problems breathing, and pain in the left arm or jaw. Women may also have pain in the upper abdomen, dizziness, lightheadedness, fainting, or extreme fatigue. Tell your doctor if you have any of these symptoms, so tests can be done.
If you ignore them, you might not find out until you have a heart attack and it’s too late. The symptoms of a stroke are different and involve the face drooping on one side, weakness or feeling numb on one side of the body, or speech difficulty. If any of these symptoms develop suddenly, call 911 immediately. Don’t just go to the ER yourself. You will be seen more quickly if you are brought in by an ambulance. In the case of a stroke or heart attack, every minute counts!
CONTROL OTHER DISEASES
Many conditions can worsen heart problems. These include high blood pressure, diabetes, and high cholesterol. Your doctor should check your blood pressure, glucose level, and cholesterol regularly. Making sure these are under control will protect your heart.
What you can do yourself
TAKE YOUR MEDS
Take your meds as prescribed. Your heart does better if your blood pressure, diabetes, cholesterol, and other conditions are under control – especially your blood pressure.
EAT A HEALTHY DIET
Diets that are high in fat, salt, or sugar can cause heart disease. A balanced diet lowers your risk of heart disease. To plan a balanced diet, ask for help from a nutritionist.
EXERCISE
Exercise helps your heart stay strong. It also helps addresses other conditions that worsen heart disease such as high glucose, blood pressure, and cholesterol. Even a bit of exercise helps, and any type of exercise — even walking — is better than no exercise. If you’re not sure where to start, ask to see a physical therapist.
DON’T SMOKE!
Smoking dramatically increases your risk of heart disease and many other diseases. If you want to quit smoking, ask your doctor for help.
DRINK IN MODERATION
Too much alcohol is unhealthy. People with HIV should have no more than one drink a day. “One drink” means one bottle of beer, one glass of wine, or one shot of gin, vodka, or other liquor.
It’s important to be honest with your doctor about how much you drink. Ask if that amount is right for you and be sure to drink safely (never while driving or using machinery). Also, ask if alcohol will interact with any of your meds.
BACKGROUND
Cardiovascular Diseases: Heart Disease, Heart Attack, Stroke, Peripheral Vascular Disease
As all of us age, whether older adults with or without HIV, the risk of cardiovascular diseases increases. However, a number of studies have shown that in older adults with HIV, the risk of heart attacks may be 50% higher than in comparison groups.
Fortunately, a great deal of this increased rate of cardiovascular diseases can be reduced by modifying known risk factors. Those factors are high blood pressure, elevated cholesterol, and smoking. Further heightening the risk of heart disease are elevated levels of HIV virus in the body (increased viral load) that can cause inflammation, which directly affects the vascular system. However, effective HIV treatment can minimize this adverse effect.
More information follows for you to understand better the issues related to cardiovascular diseases and enable you to discuss possible interventions with your healthcare team.
DISEASES AND CONDITIONS
Cardiovascular Diseases including Heart Disease:
The general term of cardiovascular diseases covers a group of disorders of the heart and blood vessels. These changes usually occur because of arteriosclerosis or atherosclerosis (the narrowing of blood vessels due to the collection of thickened debris on the inner side of blood vessels) that narrows the normal blood flow in arteries in the heart and compromises the function of the pumping muscle. This can lead to a heart attack if there is too much sudden narrowing. Other related names are myocardial infarction, coronary artery disease, and coronary heart disease. Angina pectoris causes intermittent pain in the chest, often related to exercise, and occurs due to long-term and gradual narrowing of blood vessels in the heart.
Stroke: There are large arteries in the neck that go from the heart up to the brain as well as smaller vessels in the brain that can be clogged or break open and cause a stroke with loss of body functions. There can be more slow changes in the blood vessels that can result in loss of brain tissue which may be manifested by changes in the size of the brain and reduce the speed of thinking or impair memory.
Peripheral Vascular Disease: This narrowing process can also occur in the blood vessels going to the legs and cause damage that results in pain with walking or affects the tissues in the legs causing symptoms of burning pain, or open sores. However, the HIV virus itself and some of the earlier drugs used to treat the HIV virus can have adverse effects on the nerves of the legs and cause pain. Again, adequate HIV treatment is necessary to minimize this adverse effect.
RISK FACTORS
Hypertension: High blood pressure (BP) is a major problem leading to heart disease and stroke as well as chronic kidney disease, if untreated. The BP is measured with both upper and lower values (systolic and diastolic BP). In the past doctors have accepted any measurement of 140/90 or less as normal but recent research indicates that 120/80 or below is the right level to prevent complications. There are a number of things that you can do to lower your BP:
- Reduce weight — If you are overweight, use one of the indicators such as body mass index to monitor your weight, This can be a valuable tool for BP reduction as well as controlling blood fats and diabetes.
- Decrease salt intake – Salt’s effect on BP is somewhat controversial. For some people, reducing salt intake can lower BP.
- Find the proper blend of medications to reduce BP — This is almost always possible. Check with your primary care physician. The least number of additional meds taken for achieving satisfactory BP levels is preferred to avoid too many drugs (polypharmacy).
Blood Lipids (Fats): There are four kinds of blood lipids that can affect cardiovascular health and are commonly measured and treated.
- Total cholesterol is a summation of three of these fats and is the most common measure used. A value less than 200 is felt to be optimal.
- LDL (Low Density Lipoprotein) or bad cholesterol is the most potent predictor of heart attacks. Recent research has determined that acceptable levels in the blood should be lowered from 140 to 100.
- HDL (High Density Lipoprotein) or good cholesterol is believed to be a protective factor so the higher the better. A value over 50 is thought to be adequate.
- Triglycerides can be associated with cardiovascular diseases but also pancreatitis (inflammation of the pancreas). The ideal value is considered to be 150 or less. High levels are considered 500 or greater.
In the last few years, there has been a move to combine blood lipid values with other relevant measurements to develop an indicator of longer-term risk of cardiovascular disease. These formulas are derived from large population studies and are not specific to older adults with HIV. As a result, the direct applicability of these formulas for older adults with HIV is not as clear. Your doctor may or may not use these indicators to guide treatment choices.
TREATMENT
Elevated blood lipid levels, especially LDL and triglycerides, are very responsive to appropriate treatment. The American Heart Association has information at: https://www.heart.org/en/health-topics/cholesterol.
It is possible that weight loss can be paired with a low-fat diet to decrease blood lipid levels. Increased physical activity may lead to an increase in HDL levels. If such lifestyle changes are not successful, your healthcare provider may prescribe a class of drugs called statins. These drugs both lower lipids and can reduce inflammation in the body. A major clinical trial is underway to determine if this therapy is beneficial in older adults with HIV.
Among the major predictors of cardiovascular disease, as well as chronic lung disease and cancer, is chronic smoking. The frequency of smoking among older adults with HIV is substantially higher than other populations. Studies show that is especially difficult for people with HIV to quit smoking However, despite these challenges, you shouldn’t give up. The payoff is high with better health.
In addition to participating in self-help groups, there are different treatment strategies available to reduce or quit smoking. First, nicotine patches can help you gradually reduce nicotine dependence. Also, your healthcare provider can prescribe non-nicotine medications that have good success rates for smoking cessation. (See information on how to stop smoking at: https://www.lung.org/stop-smoking/)
The bottom line is that smoking reduction or cessation can significantly reduce your risk for cardiovascular diseases.
By addressing cardiovascular risk factors, the older person with HIV can make a substantial contribution to improving his or her long-term health, well-being, and life expectancy, while continuing to maintain HIV treatment at optimal levels.
If you would like to learn more about ways to reduce your risk of cardiovascular disease, go to “New Journal Articles of Interest.” A recently published report supports the rationale for addressing smoking, elevated blood pressure and high cholesterol to lower risks of heart disease. You will also find information on “Cardiovascular Disease and Prevention in Older Adults with HIV at “Recommended Treatment Strategies” at https://aahivm-education.org/hiv-age.