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HIV infection appears to increase the
risk of heart attack
More research needed to clarify underlying
factors, how best to treat
BOSTON - April 24, 2007 - Researchers from Massachusetts
General Hospital (MGH) have found that infection with HIV, the virus
that causes AIDS, is also associated with increased risk of myocardial
infarction or heart attack. While rates of several cardiovascular
risk factors were also increased in study participants infected
with HIV, the increased incidence of heart attack was beyond what
could be explained by risk factor differences. The report will be
published in the Journal of Clinical Endocrinology and Metabolism
and has been released online.
"Our study shows a higher incidence of myocardial infarction
and major cardiovascular risk factors in HIV-infected patients,
compared with noninfected patients," says Steven Grinspoon,
MD, of the MGH Program in Nutritional Metabolism and Neuroendocrine
Unit, the report's senior author. "Those findings indicate
that those infected with HIV should be assessed for cardiovascular
risk factors and that we urgently need to develop strategies to
modify those risks."
It has been recognized that many HIV-infected individuals have metabolic
abnormalities - including altered levels of blood lipids such as
cholesterol, insulin resistance, type 2 diabetes, and changes in
fat distribution in the body. Researchers have reported that patients
taking antiretroviral medications may have increased risk of heart
attacks, but few studies have directly examined whether HIV-infected
patients in general have more heart attacks than non-infected individuals
do.
The researchers took advantage of the Research Patient Data Registry,
a database of demographic and diagnostic information on more than
1.7 million patients treated at MGH and Brigham and Women's Hospital
since 1993. They compared information on almost 4,000 HIV-infected
patients with data from more than one million patients without HIV.
Study participants were aged 18 to 84 and were seen at least twice
during the study period of almost eight years. Any patient whose
initial visit was for a heart attack was excluded from the study
group.
Across all age groups included, the risk of myocardial infarction
occurring after the initial hospital visit was markedly higher for
those infected with HIV. Although traditional cardiovascular risk
factors - such as elevated lipid levels, diabetes and hypertension
- also were more common among the HIV-infected patients and did
account for some increased risk, the increased risk for heart attack
associated with HIV remained significant even when adjusted for
those risk factors. Overall, the risk of heart attack was almost
doubled in all those with HIV and was almost tripled among women.
"Followup studies are needed to better determine why myocardial
infarction rates are higher in HIV patients, which risk factors
drive this risk most, and how smoking - which we weren't able to
completely evaluate in this study - affects this risk," Grinspoon
says. "We also need to analyze the relationship of antiretroviral
medications to cardiovascular risk. HIV medications save lives,
and patients should continue taking them as prescribed; but we want
physicians to be aware of these increased heart attack rates, watch
risk factors carefully and appropriately target their treatment."
Grinspoon is an associate professor of Medicine at Harvard Medical
School.
The study's lead author is Virginia Triant, MD, MPH, of the MGH
Division of Infectious Diseases. Additional co-authors are Hang
Lee, PhD, MGH Biostatistics, and Colleen Hadigan, MD, MPH, formerly
of the MGH Neuroendocrine Unit and Program in Nutritional Metabolism
and now at the National Institutes of Health (NIH). The study was
supported by grants from the NIH and the Mary Fisher Clinical AIDS
Research and Education Fund.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of nearly $500 million and
major research centers in AIDS, cardiovascular research, cancer,
computational and integrative biology, cutaneous biology, human
genetics, medical imaging, neurodegenerative disorders, regenerative
medicine, transplantation biology and photomedicine. MGH and Brigham
and Women's Hospital are founding members of Partners HealthCare
HealthCare System, a Boston-based integrated health care delivery
system.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
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