Silent Heart Disease Risk

Heart Disease

It is known that the risk of a heart attack is substantially higher in older people living with HIV than in those without HIV. A major factor for the increase appears to be the direct adverse effect of the virus on the heart. However, in addition there is the effect of the increased frequency of other diseases (i.e. comorbidities) such as hypertension, diabetes, and other conditions that affect the heart. The question addressed by this study is whether these diseases can be diagnosed earlier to prevent heart disease.

There were 790 HIV+ individuals participating in the study with a median age of about 50 years old. 77% were men. The goal was determining the frequency of silent or subclinical heart disease as well as similar involvement of the arteries in the neck leading to the brain. This was accomplished by doing tests that are not routinely done but known by your doctor. For example, ultrasonography (which uses high frequency sound waves) of the heart and neck arteries as well as specific blood values. The study found that 26% had asymptomatic heart disease or involvement of the neck arteries. In addition, 34% had hypertension (i.e. high blood pressure), 19% had diabetes and 14% had kidney disease that could have contributed to the early heart disease. In addition, 15% had elevated LDL cholesterol (i.e. low density lipoprotein), known as “bad” cholesterol. It was determined that 42% of the participants had two or more comorbidities.

So, what can be done to lower your silent heart disease or other atherosclerotic risk? If your health care team has not measured your cholesterol level, then this should be done. In particular if the LDL cholesterol is elevated. In addition to dietary changes and smoking cessation, the use of statin drugs is very successful in treatment of high cholesterol. If there is evidence of untreated hypertension, diabetes or other comorbidities, then these problems need to be addressed. However, it may also be appropriate for you to discuss the possibility of one of the special heart or neck tests being done, especially those that are non-invasive. Finally, any symptoms of pain in the chest, shortness of breath or increased fatigue should be reported immediately to your health care team. You and your doctor need to have a continuing dialogue about possible increased risk of heart disease so that you can get appropriate and early diagnosis and treatment.


Ghosn, J., et al. (2021). “Prevalence of Silent Atherosclerosis and Other Comorbidities in an Outpatiet Cohort of Adults Living with HIV: Associations with HIV Parameters and Biomarkers.” AIDS Res Hum Retroviruses 37(2): 101-108.