Aging Cardiology

Cardiac Risk and HIV

Significant amounts of atherosclerotic plaque have been found in the coronary arteries of people with HIV, even in those considered by traditional measures to be at low-to-moderate risk of future heart disease, according to HMS investigators at Massachusetts General Hospital who were key to coordinating the study.

The findings emerged from the global REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) study. Researchers found that the higher-than-expected levels of plaque could not be attributed only to traditional cardiovascular disease risk factors like smoking, hypertension, and lipids in the blood, but were independently related to increased arterial inflammation and immune system activation.

Cardiovascular disease is occurring among people with HIV at approximately twice the rate for people without the disease. The findings provide useful insights that may inform further studies to identify effective plaque reduction or prevention strategies, such as the possible use of statin medicines, for this patient population.

REPRIEVE is the largest study of cardiovascular disease among people living with HIV, having enrolled 7,700 participants at more than 100 clinical sites in twelve countries around the world. The Mass General-led study was made up of an ethnically diverse group of nearly 800 male and female participants between the ages of 40 and 75. Although significant narrowing of the arteries was rare in the participants, nearly a quarter of them had plaque in their arteries, which the researchers considered to be an indication of vulnerability to future cardiovascular problems. The plaque burden found in these patients was also associated with higher levels of arterial inflammation and immune system activation independent of traditional risk scores. The scientists assessed two biomarkers to determine these higher levels of inflammation: LpPLA2, linked with arterial inflammation, and interleukin-6, associated with immune system activation. The scientists found increased levels of interleukin-6 in people with HIV who were relatively healthy. Increases in this biomarker, they say, could be predictive of the damaging effects that immune system activation has over time on people who are taking antiretrovirals therapeutically for HIV.

Hoffmann U et al., JAMA Network Open, June 2021

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