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A Comparative Analysis of Cardiovascular Risk in Human Immunodeficiency Virus-Seropositive and -Seronegative
Srikrishna Varun Malayala1, Ambreen Raza2
1Department of Medicine, Jeanes Hospital, Philadelphia, PA, USA.
Insights
Human immunodeficiency virus (HIV) increases coronary artery disease (CAD) risk in pre-menopausal women. Despite similar traditional risk factors, HIV-positive women have a higher CAD risk, necessitating focused prevention strategies.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Human immunodeficiency virus (HIV) infection is linked to increased coronary artery disease (CAD) risk in women.
- Pre-menopausal women with HIV lose estrogen's cardio-protective effects, elevating their CAD risk.
- This study assesses cardiovascular risk specifically in HIV-positive pre-menopausal women.
Purpose of the Study:
- To evaluate the cardiovascular risk in pre-menopausal women with HIV.
- To compare CAD risk factors between HIV-positive and HIV-negative pre-menopausal women.
- To analyze patient and physician intent regarding cardiovascular risk reduction in this population.
Main Methods:
- Cross-sectional study utilizing National Health and Nutrition Examination Survey (NHANES) data.
- Calculation of 10-year Framingham risk scores for CAD in HIV-positive and HIV-negative women.
- Comparison of individual CAD risk factors, patient risk reduction intent, and physician advice.
Main Results:
- A significantly higher mean Framingham risk score for CAD was observed in HIV-positive women (2.12) compared to HIV-negative women (0.95).
- No significant differences were found in traditional CAD risk factors like blood pressure, HbA1c, CRP, HDL, or total cholesterol.
- A majority of HIV-positive women and their healthcare providers did not express intent or provide advice for cardiovascular risk reduction.
Conclusions:
- HIV is an independent risk factor for CAD development in pre-menopausal women.
- Despite similar traditional risk factors, HIV-positive women face a higher CAD risk.
- Emphasis on traditional risk factor reduction is crucial for managing CAD risk in HIV-positive pre-menopausal women.
Background:
Human immunodeficiency virus (HIV) has been associated with an increased risk of coronary artery disease (CAD) in women. HIV-positive pre-menopausal women lose the cardio-protective effect of estrogen and are at a higher risk for developing CAD. Our study intended to assess the cardiovascular risk in HIV-positive pre-menopausal women.
Methods:
This is a cross-sectional study using National Health and Nutrition Examination Survey (NHANES) datasets. The 10-year Framingham risk score for developing CAD was calculated for HIV-positive and HIV-negative women. The individual risk factors contributing to CAD were compared. The populations' intent to reduce their risk and their doctor's advice to reduce the risk were analyzed. A P-value < 0.05 was considered significant.
Results:
Out of the available sample of 82,091 people, 9,635 women (11.7%) met the inclusion criteria of the study. Among them, 25 women were HIV-seropositive (0.25%). Though there was no significant difference in blood pressure, hemoglobin A1c, C-reactive protein, high-density lipoprotein or total cholesterol (P > 0.05), the mean Framingham risk score in pre-menopausal HIV-positive women (mean (M) = 2.12, standard deviation (SD) = 2.73) was significantly higher than the HIV-negative women (M = 0.95, SD = 1.94) (P < 0.01). Neither did majority of the HIV-positive women intend to decrease their cardiovascular risk nor did their healthcare providers advise them to do so.
Conclusions:
The risk of developing CAD in pre-menopausal women is higher from traditional risk factors itself. While HIV is now proven to be an independent risk factor for developing CAD in women, focus should be on reducing the risk from traditional methods.
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