ASK YOUR DOCTOR ABOUT REDUCING OTHER RISK FACTORS

Cardiovascular Disease (CVD), such as heart disease and heart attack, is particularly important because HIV increases the CVD risk in older adults.  Older adults with HIV are developing CVD at about 50 percent higher rates than the general population.  While you cannot change your HIV status, there are several strategies that have been proven to decrease other CVD risk factors.

We know that cigarette smoking significantly increases CVD risk. And, the frequency of smoking is much higher in people with HIV compared to the general population. The good news is that successful approaches to smoking cessation are available, but it takes commitment to stop. The comorbidity of elevated cholesterol is also a major risk factor for CVD. However, the medication class called statins can be used to lower the bad cholesterol (LDL-C). Their use will need to be discussed with your primary care provider.  Also, you should have your blood pressure checked. If it is too high (i.e. hypertension), you may be at additional risk for CVD. When blood pressure is persistently elevated even with lifestyle changes, such as weight reduction, medications are available for treatment. 

The diagnosis and treatment of diabetes, which is a major risk factor for CVD, is important. However, diagnosis is more complicated for people with HIV. The non-fasting blood test (HbA1c) may not be the best for you.  Instead you will need to have a fasting blood sugar (glucose) level measured for an accurate diagnosis. Then, you will be able to receive proper therapy, either with changes in your diet or by a medication.  A more controversial issue is the use of daily aspirin to lower your risk of CVD. You will need to consult with your primary care provider about this, since recommendations are changing.

In summary, because of the increased risk for CVD in persons with HIV, it is critical that you reduce all risk factors for this disease.  This includes smoking cessation, tests and treatment for elevated blood cholesterol levels, management of hypertension, and the presence and management of diabetes.  All of these risk factors are treatable and can make a major difference in lowering cardiovascular disease in older persons living with HIV. For further information go to the top of the home page, open “Conditions”, and select the section on Heart Disease.

From Aberg J A (2019): Aging and HIV infection: Focus on cardiovascular disease risk, Topics in Antiviral Medicine; 27(4):102-105