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Coronary artery disease, or CAD, is more prevalent in patients with HIV than the population as a whole. CAD can be an underlying cause of several manifestations of cardiovascular disease such as:
Arrhythmia and loss of muscle
Congestive heart failure
End stage heart disease
Coronary artery disease, which is also called coronary heart disease, occurs when plaque builds up in the walls of the coronary arteries to the point that it limits blood flow to the heart’s muscles. The medical term for the restriction of blood to the heart is ischemia, and the process of plaque accumulation in the artery walls is called atherosclerosis. Ischemia may be chronic, meaning the blood supply to the heart becomes progressively more restricted over time, or it may be acute, which usually manifests when plaque suddenly ruptures resulting in a thrombus, or blood clot, developing.
HIV is considered a risk factor for CAD due to several studies that demonstrate greater incidences of CAD in HIV positive patients when compared to non-infected individuals; however, reliable data is somewhat limited because of the difficulties researchers encounter when looking for control groups.
Nonetheless, hospitalization for CAD is proportionally more common in patients living with HIV. Atherosclerosis, which is the major cause of CAD, has also been documented at higher rates in HIV patients. Some suggested reasons for higher incidences of CAD in HIV patients include: the direct impact the virus has on arteries; side effects of antiretroviral therapy; certain lifestyle risk factors that are prevalent in HIV patients, such as smoking; or a combination of all of the above.
There are currently no specific guidelines for managing CAD in patients with HIV, so recommendations for treatment and prevention are the same as those developed for HIV negative individuals. Recommendations for prevention and treatment include:
- Exercise several times a week
- Dietary adjustments including weight reduction and adequate nutrition
- Tobacco cessation
- Treatment for substance abuse
Drug treatment may be considered if the potential benefits of medication outweigh any possible risks.