NEW YORK (Reuters Health) – Patients with HIV infection who are admitted to the hospital with acute coronary syndrome (ACS) face a “substantial” risk of dying in the short-term and a significant risk of needing revascularization and suffering myocardial infarction in the longer term, new research suggests.

To mitigate these risks, close attention to modifiable risk factors and “strict follow up stressing the crucial point of adherence to drugs, and lowering hypertriglyceridemia” is needed, Dr. Fabrizio D’Ascenzo, from the division of cardiology, University of Turin, S. Giovanni Battista ‘Molinette’ Hospital, who worked on the study, noted in an email to Reuters Health.

Use of highly active antiretroviral therapy (HAART) has dramatically reduced HIV-associated morbidity and mortality, but adverse effects of HAART are “becoming an increasing challenge, especially in the setting of ACS,” Dr. D’Ascenzo and colleagues note in their report in the European Heart Journal.

They performed a meta-analysis of 11 relevant studies (2,442 patients, mean age 61 years) to “critically appraise” risk factors and outcomes in HIV patients with ACS and their relationship to antiretroviral therapy.

Overall, they found that the incidence of traditional cardiovascular risk factors in the study subjects was average; 22% had hypertension, 43% had dyslipidemia, 45% had hypertriglyceridemia and 60% were current or former smokers. The exception was type 2 diabetes, present in only 11% of subjects.

The average time from HIV diagnosis to ACS was about 7.5 years; most patients were exposed to nucleoside reverse-transcriptase inhibitors (84%) and protease inhibitors (66%).

On hospital admission for ACS, 57% of patients had ST-segment elevation myocardial infarction (STEMI), with single-vessel disease the most common angiographic presentation (53%). Percutaneous transluminal coronary angioplasty was the most common revascularization strategy used (54%).

According to the researchers, 8% of study subjects died in the hospital, most from cardiovascular events. At a median follow-up of about 25 months, no deaths were recorded, but the incidence of acute myocardial infarction was 9.4% and that of percutaneous coronary revascularization was 20%.

This analysis “confirms an important risk of non-fatal reinfarction after ACS,” the researchers say.

Pooled data from the two trials reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant increased risk (odds ratio, 2.68).

“For both cardiology and everyday clinical practice, the high risk of myocardial infarction in these patients, the low risk of death, but high risk of subsequent myocardial reinfarction and revascularization should be stressed,” Dr. D’Ascenzo told Reuters Health.


Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy

Euro Heart J 2011. Published online December 20, 2011.