Addressing the Risks
Once people at risk for heart disease are identified, those risk factors should be addressed. In fact, the Infectious Disease Society of America has stressed that all adults with HIV should be assessed for cadiac risks. And if cardiac risks are identified they must be dealt with aggressively.- Put Out The Cigarettes - One of the most beneficial lifestyle changes anyone can make is to stop smoking. Smokers have a two to four times greater risk of heart disease than do non-smokers. Add to that the greater risk of heart disease in the HIV positive person and you can see what a significant difference not smoking can make. While it can be a very difficult task, it can be made easier by attending smoking cessation programs or using medications to quell the nicotine cravings.
- Monitor Labs Closely - As part of the regular battery of blood tests, cholesterol and triglyceride levels should be included. In addition, the HDL (good cholesterol) and LDL (bad cholesterol) should be assessed. If abnormalities are in these labs, they need to be addressed either by changes in the diet or with cholesterol lowering medications.
- Keep an Eye on the Blood Sugar - Most cardiac risk guidelines focus on the cholesterol and triglycerides. There is a growing concern that high blood sugar, insulin resistance, and diabetes can pose an equal or even greater cardiac risk than does elevated cholesterol and triglycerides. In fact, elevated lipids and blood sugar goes hand in hand with HIV medications. As with elevated lipids, elevated blood sugars must be dealt with agressively through diet, dietary counseling from a dietician, and if necessary medication.
- Change Your Lifestyle - For those people who take HIV medications, the number of pills being taken each day is important. Adding more medications like cholesterol-lowering drugs and blood sugar medications adds to the medication burden, making it harder for the person to adhere to their regimen. For that reason and just because we don't want to take more medications than we need, experts agree that controlling cardiac risk factors by making lifestyle changes is preferable to medications. Eating healthier meals, lower in fats and sugars is one lifestyle change that can be made. Regular exercise is another way to reduce cardiac risk without medication.
- Shed Those Extra Pounds - People who have excess body fat, especially around the waist, are more likely to develop heart disease even if they have no other risk factors. Excess weight increases the heart's work, raises blood pressure, and elevates cholesterol and triglycerides. It can also make diabetes more likely to develop. While losing weight can be a daunting task, even dropping 10 pounds will reduce your risk of heart disease.
- Control Your Blood Pressure - Like being overweight, high blood pressure increases the workload of your heart. Chronic blood pressure will cause your heart to thicken and become stiff, decreasing its ability to pump effectively. Losing weight and exercising will help keep your blood pressure in check. However, if watching your diet and exercise is not enough to bring your blood pressure under control, there are medications that can help.
Cardiac disease will continue to be an issue in HIV positive people especially with people living longer. Understanding all the causes of cardiac disease in HIV patients requires ongoing investigation. However, in the mean time physicians must be diligent in their assessment of cardiac risk and aggressive in their treatment of those known risks. Patients must assess their health status and the choices they make, changing the things they can change in an effort to decrease their risk of cardiac disease. Cardiac health and decreasing cardiac risks must become a priority for doctors and patients; long-term health and well-being depends on it.
Sources:
American Heart Association; Risk Factors and Coronary Heart Disease; 2008.
Bernard, E.; Managing Metabolic Syndrome; Positively Aware; May / June 2004.
