Coronary Artery Disease

Christopher J. Hoffmann, M.D., M.P.H.
Coronary Artery Disease is a topic covered in the Johns Hopkins HIV Guide.

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PATHOGENS

  • HIV infection appears to increase coronary atherosclerosis and risk of acute coronary syndromes (ACS): 1.1 to 1.6x increased risk; 6-15% of deaths among HIV+ in U.S. and Europe caused by cardiovascular disease
    • Proposed mechanisms: HIV-mediated inflammation, coagulation disorders, lipid disturbances, gut translocation, and exposure to specific ART agents
  • ART agents associated with increased ACS risk (LPV/r, IDV, ABC, ddI) and increased cholesterol: greatest increase in cholesterol (>20mg/dL) with LPV/r, /r, NFV, TPV/r
    • Increased insulin resistance: most associated with LPV/r, IDV, d4T
    • Potential direct effect leading to ACS: ABC, ddI, LPV, IDV
  • 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

-- To view the remaining sections of this topic, please or --

PATHOGENS

  • HIV infection appears to increase coronary atherosclerosis and risk of acute coronary syndromes (ACS): 1.1 to 1.6x increased risk; 6-15% of deaths among HIV+ in U.S. and Europe caused by cardiovascular disease
    • Proposed mechanisms: HIV-mediated inflammation, coagulation disorders, lipid disturbances, gut translocation, and exposure to specific ART agents
  • ART agents associated with increased ACS risk (LPV/r, IDV, ABC, ddI) and increased cholesterol: greatest increase in cholesterol (>20mg/dL) with LPV/r, /r, NFV, TPV/r
    • Increased insulin resistance: most associated with LPV/r, IDV, d4T
    • Potential direct effect leading to ACS: ABC, ddI, LPV, IDV
  • 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

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Last updated: January 5, 2017