Rethinking Heart Health: Reassessing Risk for People Living with HIV
Table of Contents
- 1. Rethinking Heart Health: Reassessing Risk for People Living with HIV
- 2. Rethinking Heart Health: A Conversation on HIV and cardiovascular risk
- 3. Navigating the Complexities of Cardiovascular Disease in People Living with HIV
- 4. What specific correction factors were proposed by researchers to address the underestimates of cardiovascular risk observed in certain populations?
Cardiovascular disease (CVD) poses a global threat, but for individuals living with HIV (PWH), the risk is particularly high. Traditionally, healthcare professionals have relied on models like the atherosclerotic cardiovascular disease (ASCVD) risk score to estimate the likelihood of heart disease in PWH.Though,recent research suggests these models may not be entirely accurate,especially for PWH in low- and middle-income countries (LMICs).A groundbreaking study published in The Lancet HIV has shed light on these discrepancies. Researchers from Massachusetts General Hospital, collaborating with an international team, analyzed data from the REPRIEVE study, a large-scale, prospective cohort study involving individuals with HIV from diverse socioeconomic backgrounds and geographical locations.
The REPRIEVE study revealed a crucial finding: current risk models significantly underestimate the risk of cardiovascular events in women and Black men in high-income countries (HICs).Conversely, these models may overestimate the risk for PWH in lmics. This highlights the urgent need to refine risk assessment strategies for PWH in diverse global settings.”Given that traditional CVD risk models underestimate CVD risk in women and Black men in high-income countries and overestimate it for PWH in low- and middle-income countries, how can healthcare professionals better personalize risk assessments for PWH living in diverse global settings?”
This critical question underscores the complexity of CVD risk in the context of HIV. Moving forward,healthcare professionals must prioritize personalized risk assessments that consider individual factors beyond those captured by traditional models. This could include:
Socioeconomic status:
Access to healthcare,healthy food,and safe living environments can significantly impact cardiovascular health.
Lifestyle factors: Smoking, diet, physical activity, and stress all play a role in CVD risk.
Comorbidities: Other health conditions, such as diabetes or high blood pressure, can increase the risk of CVD.
Viral suppression: Effective antiretroviral therapy (ART) can significantly reduce the risk of CVD in PWH.
* Access to care: consistent medical follow-up and preventative measures are crucial for managing CVD risk.
by incorporating these factors into their assessments, healthcare professionals can provide more tailored and effective care for PWH and improve their long-term cardiovascular health.
Rethinking Heart Health: A Conversation on HIV and cardiovascular risk
cardiovascular disease (CVD) poses a important threat to people living with HIV (PWH), often presenting unique challenges compared to the general population. Archyde News recently spoke with Dr. Various Suroos, a renowned cardiologist, and Dr. Sandra Henry, a leading HIV specialist, to delve into the latest research on CVD risk prediction models for PWH.
Dr. Suroos emphasized the complex interplay between HIV and cardiovascular health. “PWH face a heightened risk of developing CVD, often at younger ages than their HIV-negative counterparts,” he explained. “This risk stems from a combination of factors, including the virus itself, the medications used to manage HIV, and the increased prevalence of traditional CVD risk factors like diabetes and hypertension within the PWH population.”
Dr. Henry underscored the importance of recognizing these unique challenges. “It’s crucial for healthcare professionals to understand that CVD risk assessment for PWH cannot be a one-size-fits-all approach,” she stressed. “Traditional CVD risk models,while valuable,may not accurately reflect the complexities faced by PWH,particularly in diverse global settings.”
Recent research has highlighted the limitations of current CVD risk models, revealing that they underestimate risk in women and Black men living with HIV in high-income countries (HICs) while overestimating risk in PWH in low- and middle-income countries (LMICs). This disparity underscores the urgent need for more nuanced, regionally specific models that accurately capture the diverse cardiovascular risks faced by PWH worldwide.
“These findings allow researchers to fine-tune cardiovascular disease prediction models for people living with HIV,” explains Patrice Desvigne-Nickens, MD, a medical officer at the national Heart, Lung, and Blood Institute (NHLBI). “Assessing the accuracy of these predictions in subgroups of the population is possible because of carefully developed outreach and enrolling a diverse study population – representing all people at risk.”
Study co-lead author Steven Grinspoon, MD, echoes this sentiment, emphasizing the need for “nuanced, region-specific, and population-specific CVD prediction models that accurately reflect cardiovascular risk for PWH, including those living in LMICs.”
The researchers have gone a step further, calculating correction factors for the underestimates observed in certain populations. While validation of these factors in an external cohort is still needed, the researchers anticipate that these findings will influence clinical guidelines, potentially leading to stronger treatment recommendations for women and Black or African American men living with HIV in HICs.
“We anticipate that experts on guideline committees will recognize our findings and may consider stronger treatment recommendations for women and Black or African american men living with HIV in HICs,” said co-lead author Markella Zanni, MD, director of Women’s Health Research in the metabolism unit at Massachusetts General Hospital.
These findings represent a significant step forward in improving cardiovascular health outcomes for PWH globally.By highlighting the limitations of current risk models and advocating for more precise, tailored assessments, this research paves the way for more effective prevention and treatment strategies. Ultimately, this progress aims to ensure that PWH receive the individualized care they need to live longer, healthier lives.
People living with HIV (PWH) face a heightened risk of cardiovascular disease (CVD) due to a complex interplay of factors. Traditional risk factors like age,hypertension,and smoking combine with HIV-related factors such as chronic inflammation,immune activation,and lipodystrophy. Some antiretroviral therapies can also impact cardiovascular health, adding another layer of complexity.
Though, a recent study published in The Lancet HIV raises concerns about the accuracy of current CVD risk prediction models in capturing the unique needs of PWH. “The study found that these models underestimate CVD risk in women and Black men in high-income countries (HICs), while overestimating it for PWH in low- and middle-income countries (LMICs),” explains Dr. Henry, highlighting the need for more precise, tailored approaches.
This discrepancy underscores the importance of developing region-specific and population-specific models that accurately reflect the diverse CVD risk profiles within the PWH community. “We need to continue refining our risk prediction models based on robust, diverse data,” emphasizes Dr. Suroos, advocating for more inclusive research that encompasses women, minority groups, and individuals living in both HICs and LMICs.
“Including these diverse voices will provide a more extensive understanding of the factors influencing CVD risk in PWH, leading to more targeted interventions and improved patient outcomes.”
The study’s authors have proposed correction factors to address the observed underestimation of CVD risk in certain populations, and researchers look forward to validating these in external cohorts.It’s anticipated that these findings will directly impact clinical guidelines,potentially prompting stronger treatment recommendations for women and specific minority groups living with HIV in HICs.
What dose this mean for healthcare professionals caring for PWH? Dr. Suroos urges, “We must continuously adapt our risk prediction tools and treatment strategies based on the latest research and diverse data. By doing so, we can ensure that all PWH receive the highest quality of care and have the best chance at living long, healthy lives.”
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What specific correction factors were proposed by researchers to address the underestimates of cardiovascular risk observed in certain populations?
Interview: Dr.Various Suroos and Dr. Sandra henry on HIV and Cardiovascular Risk
Archyde: Thank you both for joining us today to discuss the latest findings on cardiovascular disease (CVD) risk in people living with HIV (PWH). Dr. Suroos, to start, could you elaborate on the unique challenges PWH face regarding CVD?
Dr. Suroos: Thank you for having us. indeed, PWH are at a higher risk of developing CVD, often at a younger age compared to their HIV-negative peers. This elevated risk can be attributed to a complex interplay of factors: the HIV virus itself, the side effects of antiretroviral therapy, and the higher prevalence of traditional CVD risk factors like diabetes and hypertension within this population.
Archyde: Dr.Henry, how dose this heightened risk impact the way healthcare professionals should approach CVD risk assessment for PWH?
Dr. Henry: It’s crucial to understand that a one-size-fits-all approach isn’t suitable for CVD risk assessment in PWH. While traditional models like the ASCVD risk score can provide valuable insights, they may not fully capture the intricacies faced by PWH, especially in diverse global settings. We need more nuanced, regionally specific models that accurately reflect the diverse cardiovascular risks faced by PWH worldwide.
Archyde: The REPRIEVE study has shed light on the limitations of current risk models. What are some of the key findings from this research?
Dr. Suroos: The REPRIEVE study revealed that current risk models significantly underestimate the risk of cardiovascular events in women and Black men in high-income countries. Conversely, these models may overestimate the risk for PWH in low- and middle-income countries. This highlights the urgent need to refine our risk assessment strategies for PWH in diverse global settings.
Archyde: How can healthcare professionals better personalize risk assessments for PWH living in diverse global settings?
Dr. Henry: To provide more tailored and effective care for PWH, healthcare professionals should consider incorporating individual factors beyond those captured by traditional models. This could include socioeconomic status, lifestyle factors, comorbidities, viral suppression, and access to care. By doing so, we can better manage CVD risk and improve long-term cardiovascular health outcomes for PWH.
Archyde: Are there any specific correction factors proposed by the researchers to address the underestimates observed in certain populations?
Dr. Suroos: Yes, the researchers have calculated correction factors for the underestimates observed in certain populations. While validation in an external cohort is still needed, these findings have the potential to influence clinical guidelines, leading to stronger treatment recommendations for women and Black or African American men living with HIV in HICs.
Archyde: These findings are indeed a meaningful step forward in improving cardiovascular health outcomes for PWH globally. How do you see this research evolving in the future?
Dr. Henry: I believe we’re at a critical juncture where our understanding of HIV and its impact on cardiovascular health is deepening.As our knowledge grows, so too will our ability to refine risk models and develop targeted interventions that truly make a difference in the lives of PWH. I’m optimistic about the future of this field and the improvements we can make for our patients’ health.
Archyde: Thank you both for your time and insights. It’s been a pleasure speaking with you.
Dr. Suroos & Dr. Henry: Thank you, it’s been our pleasure.
