Early Interventions Reduce Heart Attack Risk in HIV Patients

Improved care for HIV-infected patients within the Kaiser Permanente system has essentially reversed their previously reported increased heart attack risk, according to a study published in Clinical Infectious Diseases.

Researchers evaluated myocardial infarction (MI) risk from 1996 and 2010-2011 among 24,768 HIV-positive and 257,600 demographically matched HIV-negative subjects from Kaiser Permanente Northern California and Kaiser Permanente Southern California. In 1996, the HIV-positive subjects had an 80% increased risk for MI compared with HIV-negative subjects, but in 2010-2011, there was no such increased risk.

The investigators attributed that drastic decline in heart attack risk to improved access to care and more widely distributed cardiovascular risk reduction efforts over the 16-year study period. The HIV-positive subjects also demonstrated greater use of lipid-lowering and hypertension treatments, and they were started on antiretroviral therapy (ART) earlier and prescribed less-toxic combination ARTs.

The researchers believed that the health care system’s early awareness of HIV patients’ increased heart attack risk contributed to the reductions in risk and improvements in treatment interventions within the study cohort. The resulting efforts included the implementation of health prompts in the subjects’ electronic medical records, with reminders for cholesterol and blood pressure monitoring, diabetes follow-up, and smoking cessation attempts.

“Such early and sustained improvements in care would have been necessary to achieve not only a reduction in risk of heart attack, but (also) a virtual leveling of risk between HIV-positive and HIV-negative individuals,” said senior study author Michael J. Silverberg, PhD, MPH, in a statement. “The takeaway from this study is that the well-established higher risk of a heart attack in HIV patients may be reversible. With better HIV treatments, and more attention to traditional cardiovascular risk factors, the difference in risk by HIV status has been diminished or even eliminated.”