by Jean Kressy, MS, RN, with Christine Wanke, MD, and Jül Gerrior, RD
It is well known that HIV-positive patients on anti-retroviral drug therapy can have higher than normal levels of blood lipids (cholesterol, LDL [bad] cholesterol, and triglycerides) that put them at greater risk of developing coronary heart disease (CHD). However, unless there are other risks that normally increase the chances of having a heart attack, such as family history of heart disease, smoking, or high blood pressure, HIV-positive people are not necessarily at greater risk for cardiovascular disease than HIV-negative people.
Health experts, concerned about the possible long-term effects of HIV drug therapy on their patients, are looking at ways to protect them from developing heart disease. In addition to changing or even discontinuing HIV medications, physicians advise HIV-positive patients to make the same lifestyle changes that they recommend to anyone at risk for heart disease. Some risks, like age and race, can’t be changed, but others, such as smoking and diet, can be. In many cases, a single change, like increasing exercise or losing weight, can reduce multiple risks.
Risks for CHD that can’t be changed:
As people get older, their chances of developing CHD increase. Risk increases for men over 45 and women over 55.
Men have a greater risk of CHD than women, and they have heart attacks earlier in life.
People whose parents or siblings have a history of premature CHD (before age 55) are more likely to develop it themselves. African-Americans have more severe high blood pressure (hypertension) than Caucasians; this puts them at greater risk of heart disease.
Risks for CHD that can be changed and how to do it:
Smoking, especially cigarettes, as much as doubles the risk of heart attack; furthermore, smokers are more likely to die within an hour of an attack than nonsmokers. HIV-positive smokers on anti-retroviral medication may be at even greater risk for developing high blood lipids, a major risk for CHD. When nonsmokers are constantly exposed to smoke, their risk for heart disease increases. People who smoke cigarettes, cigars or pipes should stop. For people who quit, even those who have been smoking for years, the risk for heart disease decreases over time.
- High blood lipids:
Abnormally high levels of cholesterol, LDL cholesterol, and triglycerides, a common side-effect of anti-retroviral medications, increase the chances of CHD. To reduce blood lipids, nutrition experts recommend diets low in fat, especially saturated fat (fatty cuts of meat, poultry with skin, whole-milk diary foods, and coconut and palm oils). Cholesterol, also found in animal foods, should be limited. As a rule, foods high in saturated fat also contain cholesterol; the exception is vegetable oils, which are cholesterol-free. When eating fat, choose unsaturated fats such as canola, olive and corn oils and use soft margarines. Diets should be high in fiber-rich whole-grains, legumes, fruits and vegetables—especially citrus fruits and green and yellow vegetables. In addition to being low in fat, these foods are excellent sources of vitamins and minerals.
High blood pressure, which makes the heart work harder, causing it to enlarge and weaken, increases the risk of heart attack and stroke. Obesity, smoking, high alcohol consumption, inactivity, and high-fat diets increase the chances of developing hypertension. In some people, high-salt intake raises blood pressure. Know your blood pressure and if it’s high, make diet and lifestyle changes to lower it. If you’re overweight, a loss as little as ten pounds can make a difference.
Excess body fat, especially around the abdomen, increases the risk of developing heart disease. Truncal or abdominal obesity, a common side-effect of anti-retroviral medications, increases CHD risk for HIV-positive patients. Losing weight and keeping it off calls for a three-part strategy that includes diet, exercise, and behavioral skills.
See "Unintentional Weight Gain."
Physical exercise decreases the risk of heart disease. In addition to preventing heart and blood vessel disease, regular, moderate-to-vigorous activity can help control cholesterol, diabetes, and obesity. In some people, exercise can help lower blood pressure. A good exercise plan includes aerobic exercises such as fast walking, swimming, and cycling. By raising the pulse rate, aerobic exercises increase blood flow to all muscles, including the heart, making it stronger.
Diabetes, even when under control, is a serious risk factor for heart disease. Insulin resistance, a common side-effect of medications used to treat HIV, increases the risk of diabetes, especially in patients who are older or have a family history of the disease. In addition to medication to treat diabetes, there are lifestyle changes that can make the disease easier to control. When patients are overweight, for instance, losing a few pounds can help. For patients who are inactive, physical exercise, which reduces the need for insulin, is recommended. Lastly, a balanced eating plan, specifically designed for the patient, makes diabetes easier to control.
Health experts say drinking too much alcohol (more than one drink a day for women and two for men—one drink equals 1 1/2 ounces of liquor, 4 ounces of wine, or 12 ounces of beer)—can raise blood pressure and cause heart failure. In addition, it can increase triglycerides in the blood and the risk of high blood pressure and stroke. Cocaine users are also more likely to have heart attacks. People who drink more than the daily limit should cut back. For cocaine users, rehab programs are recommended.