Increased Cardiovascular Risk Indices in HIV-Infected Women

Cardiovascular disease is the leading cause of death in women, responsible for more deaths each year than all other causes combined.1-3 As we know, the incidence of myocardial infarction in women increases dramatically after menopause, and overall mortality as a result of coronary heart disease (CHD) is higher in women than in men, an effect largely due to comorbidities that include increased age, smoking, dyslipidemia and obesity.4,5

Multiple studies have reported an increase in cardiovascular disease associated with HIV therapy, particularly with use of protease inhibitors.6,7 Fat redistribution syndromes are also associated with HIV therapy, and visceral or abdominal obesity in particular is associated with a metabolic syndrome that may significantly increase the risk of cardiovascular events. Women (and men) living with HIV may be more at risk for cardiovascular events than HIV-uninfected women due to increased risks for lipodystrophy and dyslipidemia, which may be associated with accelerated atherosclerosis as well as insulin resistance.7 Little is known, though, about the actual increased risk these women are facing.

Inflammation has a role in the pathogenesis of cardiovascular events; therefore, measuring markers of inflammation has been proposed as a method to improve the prediction of these risks.8

Sara Dolan and colleagues investigated the use of newer inflammatory markers in evaluating the cardiovascular risk of HIV-infected women compared with that of a comparable control group of healthy females. C-reactive protein (CRP), interleukin-6, adiponectin, lipid and glucose levels were measured. Although age and weight were similar in both groups, the HIV-infected women had more abdominal visceral fat and less extremity fat by both computed tomography and dual-energy X-ray absorptiometry scans, as well as a higher waist-to-hip ratio. They also had higher CRP (the Women's Health Study found that CRP is a strong independent risk factor for cardiovascular disease in women8-10), higher triglycerides and serum glucose after a glucose challenge test, higher fasting insulin, and lower high-density lipoprotein cholesterol and adiponectin (low serum concentrations are associated with type II diabetes) when compared with the control group while controlling for smoking and use of hormone replacement therapy.

These findings clearly show increased risk factors for cardiovascular disease in HIV-infected women, and indicate that abnormal fat redistribution is quite significantly associated with increased cardiovascular risk indices. These results should encourage medical providers to monitor female patients more closely for cardiovascular risk factors, and to develop strategies to reduce their risks. This is essential when women are potentially living longer with HIV, and more women are living beyond menopause, when they typically face an even greater risk for cardiovascular events.


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