Coronary Artery Disease
- 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
- Central obesity
- Genetics (family history of MI < 55 yrs)
- Advancing age
- Behavioral factors
- Recreational drug use (especially cocaine)
- Lack of exercise
- Poor food choices
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