Lifestyle interventions and conventional treatments both play a critical and independent role in improving cardiovascular outcomes in people living with HIV, according to study results published in Clinical Infectious Diseases.
Researchers enrolled 7382 participants from the Randomized Trial to Prevent Vascular Events in HIV trial (ClinicalTrials.gov Identifier: NCT02344290). Participants’ demographics and HIV features were characterized according to the American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE) for atherosclerotic cardiovascular disease predicted risk and cardiovascular health evaluated by Life’s Simple 7 (LS7).
Participants had a median age of 50 years and 69% were natal males; 45% were Black or African American, 35% White, and 13% Asian.
Among the participants, cardiovascular risk factors were common. Half (50%) were current or former smokers, 19% had a family history of premature cardiovascular disease, and 36% had hypertension. Median body mass index (BMI) was 25.9 kg/m2, and 29% had a history of treatment for depression. Overall, the median PCE risk score was 4.5% (Q1, Q3: 2.2, 7.2), with 29% having a score below 2.5%, the lowest category, and 9% scoring above 10%, the highest category.
A strong contribution of hypertension treatment and blood pressure across all subgroups was implied by the distributions of modifiable PCE components across risk score categories and by the percentage of smokers increasing with increasing risk score category. After adjustment, longer antiretroviral therapy duration, entry antiretroviral therapy regimen, lower nadir CD4, and higher entry CD4 were associated with higher PCE risk score (P <.001), but the effect sizes were small.
The median LS7 score was 9 out of 14 (Q1, Q3: 7, 10). Ideal cardiovascular health indicated by a score of at least 5/7 ideal components was observed in 10%, and 24 participants (0.3%) had 7/7 ideal components. No more than 2 ideal components was scored by 36%, who were considered in poor cardiovascular health.
Ideal health was more common in low sociodemographic index countries and among Asians; there was no variation in the distribution of LS7 across age or natal sex. Poor diet and physical activity patterns on the LS7 were observed across all PCE scores.
Study limitations included the potential for inclusion and exclusion criteria shaping some distributions and that the study was not a randomized trial of antiretroviral therapy and could not be used to compare cardiovascular disease risk between treatment groups.
According to the researchers, the findings “strongly suggest that key health behaviors should be assessed, in addition to standard risk, to better understand [cardiovascular] health in [people living with HIV].” They added that “lifestyle interventions may be indicated regardless of [cardiovascular] risk estimate and/or conventional treatment.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Douglas PS, Umbleja T, Bloomfield GS, et al; REPRIEVE Investigators. Cardiovascular risk and health among people with HIV eligible for primary prevention: insights from the REPRIEVE trial. Clin Infect Dis. Published online June 16, 2021. doi:10.1093/cid/ciab552