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Cardiovascular risk prediction in people with HIV:
looking beyond low-density lipoprotein cholesterol
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nov 2026
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Recent clinical findings have suggested that increased plasma triglyceride (TG) levels and decreased high-density lipoprotein cholesterol (HDL-C) levels, which have been linked to metabolic syndrome and cardiovascular disease , may play a role in predicting the risk for ASCVD in this population.
The analysis, initially presented at the 75th Annual Scientific Session of the American College of Cardiology (ACC 2026), included more than 10 000 adults with HIV on stable antiretroviral therapy (ART), whose fasting lipid levels were recorded in the TriNetX database between 2015 and 2025. People with hypertension, diabetes, chronic kidney disease, familial hypercholesterolemia, or preexisting cardiovascular disease were excluded, as were those who had detectable HIV RNA ≥20 copies/ml.
he analysis revealed that high TG/HDL-C ratios (TG 150–400 mg/dl and HDL-C ≤49 mg/dl) were associated with greater odds of adverse outcomes in individuals with low and intermediate LDL-C levels compared with low TG/HDL-C ratios (TG ≤149 mg/dl and HDL-C ≥50 mg/dl). A similar trend was observed in PWH with high LDL-C levels, but this association did not reach statistical significance. Low TG/HDL-C ratios were associated with the lowest rates of adverse cardiovascular events across all LDL-C categories . The researchers concluded that the TG/HDL-C ratio may capture residual cardiovascular risk that is not reflected in the LDL-C levels and may emerge as a valuable adjunct marker for risk stratification, particularly for the aging adults with HIV.
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