HIV is not an independent risk factor for severe heart disease

Infection with human immunodeficiency virus (HIV) is no longer an automatic death sentence, thanks to the use of highly active anti-retroviral therapy (HAART). However, several studies questions have suggested that HIV infection poses a serious threat to the heart — specifically, that HIV positivity leads to an increased risk for the development of angiographically severe coronary artery disease (CAD). But Emory research presented by Amar D. Patel, MD, today at the American College of Cardiology (ACC) 54th Annual Scientific Sessions in Orlando today reaches a different conclusion.

Emory researchers studied all patients who underwent cardiac catheterization (due to acute coronary syndrome or an abnormal cardiac stress test) at Grady Memorial Hospital in Atlanta between January 2001 and December 2001. The patients were evaluated for HIV infection, common cardiac risk factors, HAART, and findings on coronary angiography. “We then used multivariate analyses to determine the relationship between HIV status and angiographically severe CAD in 525 patients,” explains Emory Heart Center cardiologist and research team member Srikanth Sola, MD. “We found that 5 percent were HIV positive and 21 percent were admitted with a heart attack. But only 1.4 percent of the heart attack group was HIV positive.”

Cardiac catheterization revealed that 213 patients (45%) had severe CAD stenosis and 14 patients of these patients were HIV positive. “At first, it appeared that HIV status was significantly associated with angiographically severe heart disease. However, after we adjusted for age, gender, hypertension, diabetes, high cholesterol levels and tobacco use, HIV status was no longer associated with severe CAD,” says Dr. Sola. “In fact, there was no significant relationship between angiographically significant CAD and HAART, CD4 count, or HIV viral load.”

The Emory researchers concluded that, although HIV infection is common in an urban population referred for cardiac catheterization, it was not a significant risk factor for severe CAD. “This suggests that factors other than HIV play a significant role in the development of severe CAD in patients who are HIV positive. Lifestyle and traditional cardiac risk factors (hypertension, hyperlipidemia, tobacco, etc.) appear to play a larger role than HIV in the development of CAD,” Dr. Sola states.

He adds that the researchers were surprised by their findings. “We expected to see a strong relationship between HIV status and angiographically significant CAD,” Dr. Sola says. “However, earlier studies were conducted in an era when effective therapy against HIV was not available. At that time, the severity of HIV infection may have been greater, leading to the association between HIV infection and CAD that was noted in these earlier studies.”

In addition to Dr. Sola and Dr. Patel, the Emory research team included Tarek Helmy, MD (principal investigator); Divya Gupta, MD; Muhammad Mir, MD; Megan Price, MD; Patrick Caneer, MD; Faiz Cheema, MD; and Bobby Khan, MD.