Cardiovascular Disease Imaging in HIV
Novel Phenotypes and New Targets for Risk Reduction
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- cardiovascular disease
- carotid intima-media thickness
- coronary angiography
Because of the success of new, potent antiretroviral therapy, life expectancy has significantly improved among HIV-infected patients.1 However, an opposite trend has been noted for cardiovascular disease (CVD) among patients with HIV. Cardiovascular morbidity and mortality have increased since 1999,2 and CVD has become a significant public health issue among HIV-infected patients in whom rates of myocardial infarction and stroke may be up to twice as high as compared with similarly age-matched patients in the general population.3,4 Although HIV-infected patients may exhibit increases in specific CVD risks, including excess smoking rates, higher rates of insulin resistance and diabetes mellitus, and dyslipidemia, carefully controlled studies demonstrate that the excess rates of CVD persist after controlling for traditional risks.3,4 One important question for the HIV community is whether statins work to improve CVD rates and whether traditional algorithms designed for the non-HIV population can be used to identify those patients with HIV who might benefit from statin therapy.
See Article by Phan et al
Among patients with HIV, an important concern is whether risk prediction algorithms that rely on traditional risk factors, such as the newly recommended American College of Cardiology/American Heart Association (ACC/AHA) guidelines, can accurately identify those patients with HIV who should be recommended for statin therapy. Retrospective cohort studies have been inconsistent in determining the use of these equations. Some studies suggest that the new 2013 ACC/AHA algorithm, that was not determined based on data from patients with HIV, may indeed underestimate CVD rates, especially in young patients at lower risk thresholds, but also potentially overestimate at higher risk thresholds.5 In addition, key questions of sex and racial differences remain as to the use of these equations. Uniquely, relative CVD rates (HIV versus control) are higher in women,3 and …