Current methods to predict the risk of heart attack and stroke vastly underestimate the risk in individuals with HIV, which is nearly double that of the general population, reports a new Northwestern Medicine study. “The actual risk of heart attack for people with HIV was roughly 50 percent higher than predicted by the risk calculator many physicians use for the general population,” said first author Dr. Matthew Feinstein, a cardiovascular disease fellow at Northwestern University Feinberg School of Medicine. The study was published in JAMA Cardiology.
The higher risk for heart attack about 1.5 to two times greater exists even in people whose virus is undetectable in their blood because of antiretroviral drugs. Accurately predicting an individual’s risk helps determine whether he or she should take medications such as statins to reduce the risk of heart attack or stroke.
The study was conducted using a large, multi-center clinical cohort of HIV-infected individuals receiving care at one of five participating sites around the country. Researchers analyzed data from approximately 20,000 HIV-infected individuals. They compared predicted rates of heart attacks based on data from the general population to the actual rates of heart attacks observed in this cohort.
Scientists believe that primary driver of the higher risk is the HIV-related chronic inflammation. Plaque buildup occurs 10 to 15 years earlier in HIV patients than in the uninfected population. In addition to inflammation and other effects from the virus as factors in higher heart attack and stroke rates, senior study author Dr. Heidi Crane also pointed to higher rates of traditional risk factors like smoking.
“Despite these differences, we found that risk scores developed in the general population — while not as accurate as we would like are still useful in assessing risk in HIV populations,” said Crane, associate professor of medicine at the University of Washington. “More research is needed to develop better ways to assess risk in HIV. “
Feinstein and colleagues hope to collaborate with a large multi-center HIV cohort to develop a new algorithm. They attempted to do it with this study, but 20,000 patients weren’t enough for an accurate predictor. The current tool for predicting heart attack risk for the general population is based on more than 200,000 patients.
“Regardless of age, sex or race, the risks are higher in people with HIV,” Feinstein said. Of HIV-infected groups, the study found the current predictor tool was least accurate in African American men and women and most effective for Caucasian men.
A clinical trial is underway at Northwestern Medicine to evaluate how well common medications for heart disease prevention and treatment, such as statin medications, work to prevent heart disease in the HIV-infected population.
Citation: Feinstein, Matthew J., Robin M. Nance, Daniel R. Drozd, Hongyan Ning, Joseph A. Delaney, Susan R. Heckbert, Matthew J. Budoff, William C. Mathews, Mari M. Kitahata, Michael S. Saag, Joseph J. Eron, Richard D. Moore, Chad J. Achenbach, Donald M. Lloyd-Jones and Heidi M. Crane. “Assessing and Refining Myocardial Infarction Risk Estimation Among Patients With Human Immunodeficiency Virus: A Study by the Centers for AIDS Research Network of Integrated Clinical Systems”. JAMA Cardiology 2016 vol: 43 (1) pp: 27-34
Research funding: National Institutes of Health, American Heart Association.
Adapted from press release by Northwestern University.