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Risk for Increased Heart Disease in 45-Year Old Women with HIV and Lipodystrophy
Written for NATAP by Jules Levin
This study was reported at the 3rd Lipodystrophy Workshop in Athens (Oct 23-26, 2001). I reported in an earlier report from this conference that Vincent Mooser, Lausanne University Hospital, Lausanne Switzerland delivered an oral talk about the risk for heart disease in HIV-infected persons. He noted that there are associations between use of protease inhibitors and elevated lipids or fats, and how additional risk factors are shared between these patients and non-HIV-infected population. There is some data suggesting patients receiving HAART are at increased risk for heart disease but the data is scant. This could be because the follow-up for these patients is too short a time span. As years go by if increased fat levels are sustained the risk for heart disease may be clear.
He talked about how his findings are that risk factors in non-HIV infected patients are the same risk factors for HIV-infected: smoking cigarettes, diet, exercise, being sedentary, hypertension, family history, cholesterol insulin resistance, diabetes. These are factors that patients can take action to improve.
Steve Grinspoon, from the Neuroendocrine unit at Massachusetts General Hospital, reported in a poster at Athens (abstract 125) that measured carotid intima-media thickness (fat plaque in the artery) in 22 HIV-infected women with lipodystrophy: fat redistrubtion in the neck, face, abdomen, re extremities, Age was 45 years and body mass index was 26.4 Duration of HIV therapy was 7 years and cd4 count was 500. Fasting insulin (15.4), LDL (bad cholesterol) (120) and waist-to-hip ratio (0.96) were markedly increased. Carotid IMT was 0.62mm among the womwn, 0.62mm among Caucasian women (n=10), and 0.64mm among African-American women (n=8). Compared with age, gender, and race matched population norms, carotid IMT was significantly increased among the HIV-infected patients, p=0.01 for Caucasians (norm is 0.55) and p=0.04 for African-Americans (norm is 0.59). The carotid IMT observed in these 45 year old women is about equivalent to that predicted among 55-year old women. Among all patients, carotid IMT correlated significantly with age, diastolic blood pressure, BMI, and fasting insulin. No relationship was seen with smoking, protease inhibitor use, or other antiretroviral therapies. These data are the first to demonstrate increased carotid IMT in women with HIV lipodystrophy. Increased carotid IMT is likely a function of many factors in these patients, including elevated insulin and related elevated fats or metabolic measures. Further studies are needed to determine more definitely if HIV-infected women with lipodystrophy are at increased risk for heart disease, such as stroke and myocardial infarction.
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