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July 19, 2011

IAS 2011: Cardiovascular Risk Management: A Multidisciplinary Effort

Cardiovascular Risk Management: A Multidisciplinary Effort

Should you avoid abacavir and protease inhibitors? Not necessarily, according to a study from San Francisco’s Shared Perspectives on Therapy (SPOT) collaborative, in which heart age and 10 year cardiovascular risk were assessed using the Framingham Heart Study tool in 1000 patients in the cohort. Some results: average cholesterol, 180; 20% of patients on antihypertensive treatment; 10% were diabetics. The Heart Age cardiovascular risk calculator revealed an average 10 year risk of 12% and an average cardiac age of 55 (average chronological age, 50 years).

Their conclusion drives the point home – and we have heard this before, but it’s worth repeating. There is a vigorous debate about the extent to which HIV infection contributes to premature aging. However, investigators agree HIV care includes management of cardiovascular risk factors. We know also that there is a higher prevalence of comorbidities such as cardiovascular disease and hypertension in HIV patients. Smoking is more prevalent in this population (60 to 70% in some studies). Some investigators recommend changing HIV regimens to deal with cardiovascular risk.

The authors inject a note of caution regarding the impulse to change regimens and I quote: “However, it would be prudent to vigorously counsel smoking cessation, control of dyslipidemia and hypertension, all maneuvers which can dramatically alter risk.”

Reporter Comment: in other words, individualization of therapy plays an important role in HIV medicine. Equally, and perhaps more important is that managing cardiovascular risk is multifactorial. Without lifestyle changes (e.g smoke cessation attempts, diet, exercise) and management of metabolic changes, a regimen change is not enough.

Reference: Dyner T, Cafaro V, and Chow V. Cardiovascular risk in aging HIV patients[Abstract]. July 19, 2011 at the 6th IAS Conference on Pathogenesis, Treatment and Prevention, Rome, Italy. Abstract CDB443.

Source: Reporting for PRN News from Rome, Italy: Bill Valenti, MD