Heart disease prevention.

Though it can take years for official statistics to become available, clearly we are hearing of more heart attacks and deaths among young people who would not previously have been considered at high risk. While some antiretroviral drugs contribute to risk factors, long-term prospective studies have shown increased risk and death from cardiovascular disease before the protease inhibitors and modem combination treatment became available. (1) We strongly suspect that antiretroviral treatment is increasing cardiovascular disease in two very different ways -- by side effects of the drugs themselves, but also by keeping people alive longer so that have more chance to develop long-term effects of ATDS.

Much can be done:

* Cardiologists have found conditions that predict much greater risk of death in persons with HIV. (1) Often these can be treated.

* Cardiovascular risks are cumulative. Even when some are unavoidable due to HIV or the treatments currently available, others can be reduced by following standard guidelines published for the general population.

* Risk can be reduced by lifestyle changes such as better diets, exercise, quitting smoking, and probably by drinking a glass of red wine a day (for some patients).

* On diet, more evidence is showing that trans fatty acids (found in partially hydrogenated oils used in commercially baked goods and fast foods -- but also found in products from ruminant animals) seem to be associated with seriously increased risk of heart attacks. (2, 3)

* Nutritional approaches still considered experimental include measuring homocysteine in the blood and using certain supplements to help reduce it if necessary.

* When nutritional and lifestyle changes are not enough, prescription drugs are already used in HIV treatment to help control abnormal lipid levels or other metabolic changes that increase cardiovascular risk. These drugs are widely used in the general population. They can have side effects and should be closely monitored, especially for persons with HIV.

Almost certainly, cardiovascular illness and death of people with HIV could be significantly reduced if everybody could see an HIV specialist, and when needed an HIV-knowledgeable cardiologist, with the different doctors able to work together, and with enough time to work with their patients. In practice almost nobody gets ideal medical care.

What activists can do is to help make sure that both standard, and credible experimental, medical information on reducing the risk become more widely available in the AIDS community. We need to pay more attention to this issue, and to the many lifestyle and medical options for dealing with it. We can educate ourselves, distribute information, and work to assure that HIV patients can see HIV specialists -- and cardiologists when necessary.

References

(1.) Barbaro G, Fisher SD, Pellicelli AM, and Lipshultz SE. The expanding role of the cardiologist in the care of HIV infected patients. Heart. 2001; volume 86, page 365-367.

(2.) Oomen CM, and others. Association between trans fatty acid intake and 10-year risk of coronary heart disease is the Zutphen Elderly Study: a prospective population-based study. The Lancet. March 10, 2001; volume 357, issue 9258, pages 746-751.

(3.) Aro A. Complexity of issue of dietary trans fatty acids. The Lancet. March 10, 2001; volume 357, issue 9258, page 732.