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Addressing gaps in cardiovascular care for people with HIV: bridging scientific evidence and practice
Albert Liu1, Matthew Feinstein1,2
1Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine.
Insights
People with HIV face higher cardiovascular disease risks due to unique factors and traditional risks. Early screening and intervention are crucial for managing this excess cardiovascular disease burden.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- People with HIV (human immunodeficiency virus) experience a disproportionately high burden of cardiovascular disease (CVD).
- This excess CVD risk stems from a combination of HIV-specific factors, traditional atherosclerotic CVD risk factors, and sociodemographic disparities.
Purpose of the Study:
- To review the reasons behind the elevated CVD burden in people with HIV.
- To highlight challenges in accurate CVD risk prediction and undertreatment in this population.
- To emphasize the need for targeted interventions to address CVD disparities.
Main Methods:
- Review of current literature on CVD risk in people with HIV.
- Analysis of factors contributing to CVD disparities.
- Examination of current risk prediction tools and treatment guidelines.
Main Results:
- Accurate CVD risk prediction is challenging, potentially underestimating risk in people with HIV without considering HIV-specific enhancers.
- People with HIV are frequently undertreated for CVD, including inadequate lipid-lowering therapy.
- Structural racism and HIV-related stigma contribute to disparities in care.
Conclusions:
- Existing CVD risk prediction tools should be utilized for people with HIV.
- Prompt referral for lifestyle and pharmacologic interventions is necessary for high-risk individuals.
- System-level research is vital to reduce CVD care gaps, especially in vulnerable and low-resource settings.
Purpose Of Review:
People with HIV continue to have an excess burden of cardiovascular disease compared to the general population. The reasons for these disparities in cardiovascular disease include HIV-specific risk enhancers, traditional atherosclerotic cardiovascular disease risk factors, and sociodemographic disparities, all of which are ripe targets for intervention.
Recent Findings:
Accurate risk prediction of atherosclerotic cardiovascular disease remains difficult, and cardiovascular risk for people with HIV may be underestimated in the absence of HIV-specific risk enhancers. Despite this increased cardiovascular risk, people with HIV are undertreated and often placed on inadequate lipid lowering therapy. Structural racism and HIV-related stigma play a role, and provider-level and structural-level interventions to encourage early identification and treatment of persons at high risk are necessary.
Summary:
Persons with HIV should be screened with existing cardiovascular risk prediction tools, and those at high risk cardiovascular disease should be promptly referred for lifestyle and pharmacologic interventions as appropriate. System-level implementation research is ongoing in attempts to narrow the gap in cardiovascular care, particularly for vulnerable communities in low resource settings.
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