Coronary Artery Disease

PATHOGENS

• HIV infection increases coronary atherosclerosis and risk of acute coronary syndromes (ACS): 1-2x increased risk; 6-15% of deaths among HIV+ in U.S. and Europe caused by cardiovascular disease
  • Proposed mechanisms: HIV-mediated inflammation, immune activation, immune dysregulation (abnorml CD4:CD8 ratio), coagulation disorders, lipid disturbances, gut translocation, and exposure to specific ART agents
• ART substantially reduces CVD risk, but does not neutralize the risk for all people living with HIV.
• ART agents in the past have had a contribution to CVD risk (LPV/r, IDV, ABC, ddI). Current agents (except possibly for ABC) are not directly associated with CVD risk.
• Traditional risk factors:
  • Hypercholesterolemia and low HDL
  • Hypertension
  • Diabetes
  • Central obesity
  • Genetics (family history of MI < 55 yrs)
  • Advancing age
• Behavioral factors
  • Smoking
  • Recreational drug use (especially cocaine)
  • Lack of exercise
  • Poor food choices