HIV Patients With Diabetes Have Higher Heart Risk
Human immunodeficiency virus (HIV) patients with heart disease or diabetes have a higher risk for subsequent coronary events than HIV patients without heart disease or diabetes, according to a report in Circulation: Journal of the American Heart Association.
Researchers investigated the risk of a new episode of coronary heart disease from a database of more than 33,000 HIV patients in Europe, Australia and the United States according to their histories of coronary heart disease and whether they had diabetes or not. They found:
• Six-hundred and ninety-eight HIV patients experienced a coronary heart disease event, such as heart attack, the need for a coronary procedure or death, during the data collection from 1999 to 2007.
• Patients who had previously had a coronary heart disease event were 7.5 times more likely to have a new event compared to those who had not previously had an event.
• Patients with diabetes were 2.4 times more likely to experience a coronary heart disease event than those without diabetes.
"Both diagnoses were associated with an increased risk of coronary heart disease, independently of each other," said Signe W. Worm, M.D., lead author of the study and clinical research associate at the Copenhagen HIV Programme (CHIP) at the University of Copenhagen in Denmark. "Furthermore, we found that the risk of coronary heart disease increased as the time since diagnosis of diabetes increased — which emphasizes the importance of regular screening for this potentially preventable disease."
Guidelines on treating HIV patients with diabetes, including types 1 and 2 and gestational diabetes, who are at risk of coronary heart disease, are based on recommendations from the general population. However, it's not clear whether these recommendations can simply be extrapolated to persons infected with HIV.
"An increasing number of HIV patients are being diagnosed with diabetes, which may be a result of high levels of conventional risk factors (such as older age, physical inactivity and obesity)," Worm said. "But diabetes may also occur as a side effect of some of the drugs used to treat HIV. We conducted this analysis to get a better understanding of the relative contribution of an HIV-infected individual's history of coronary heart disease and diabetes to his or her subsequent risk of coronary heart disease.
"We found that there is a need for targeted interventions, such as regular physical exercise, smoking cessation and use of cholesterol-lowering drugs, to reduce the risk of coronary heart disease in patients with diabetes and also in those with a history of a coronary heart disease," Worm said.