The Positive Side

Winter 2011 

Keep Your Ticker Tocking

As if living with HIV isn’t enough, it’s becoming increasingly clear that HIV-positive people have a higher risk of heart disease. Fortunately, there are many things you can do to keep your heart healthy. Sean Hosein and Debbie Koenig chime in.

A FEW YEARS BACK, 12 years after being diagnosed with HIV, Abel suffered a heart attack. He was 70 years old. Abel smoked, he did not exercise, and he loved his steak, burgers and fries.

Jean-Claude, 37, also suffered a massive heart attack. He had started anti-HIV therapy three years earlier and his doctor was perplexed: Jean-Claude didn’t smoke, he wasn’t overweight or physically inactive, he didn’t have high blood pressure and he had no family history of heart disease. In short, he had no risk factors for heart disease.

While people like Jean-Claude can, and sometimes do, develop heart disease, the vast majority of people living with HIV/AIDS (PHAs) who have a heart attack or some other kind of heart trouble also have traditional risk factors for cardiovascular disease. In other words, cardiologists are far more accustomed to seeing people whose life situations resemble Abel’s than Jean-Claude’s. The upside is that there is much you can do to lower your risk.

Risk factors for heart disease

Although you may not associate having HIV with heart disease and you may think of heart trouble as something that affects only older people, new research suggests that people with HIV, including relatively young people, are at greater risk than the general population. So, regular monitoring of your heart health should be part of your plan for living longer and living well.

During the first two decades of the HIV epidemic, doctors focused on preventing and treating life-threatening infections. However, now that more effective antiretroviral therapy (ART) is widely available in high-income countries like Canada, deaths from life-threatening infections are uncommon here. As a result, HIV-positive people are living much longer, and as they get older, they become more vulnerable to diseases that can come with aging — including heart disease.

Another factor that’s making heart disease more common among PHAs is the inflammation that occurs as a result of HIV infection, especially if HIV goes untreated. This happens because HIV can cause the immune system to be in a continuous state of inflammation. This inflammation damages the immune system, increases the risk of heart disease and harms other internal organs. It also accelerates the aging of blood vessels.

Taking ART can greatly decrease HIV-related inflammation. Indeed, studies have found that people who stop taking ART have a greatly increased risk for heart attacks and stroke. However, even when a person has a low or undetectable viral load, low-level inflammation triggered by HIV may heighten their risk for heart disease.

At the same time, some of the medicines used to treat HIV can raise lipid levels — fatty substances in the blood, such as cholesterol and triglycerides — which increase a person’s risk for heart disease. This is why it’s crucial that your doctor monitor your lipid levels regularly. Many HIV-positive people who use these medicines take other steps to ensure that their lipid levels stay as low as possible.

Smoking is the number one risk factor for heart disease among PHAs. You may also be at greater risk for heart disease if you: have parents or siblings who have had heart disease; have diabetes, high blood pressure or abnormal cholesterol levels; are a man older than 45 or a woman older than 55; carry around extra weight, particularly around your midsection; experience depression or high levels of stress; don’t get enough physical exercise; or use street or party drugs such as cocaine, ecstasy, heroin or crystal meth.

It is important to discuss any and all of your risk factors with your doctor to determine your overall risk for heart disease.

What you can do

There’s not much you can do about risk factors like your age or family history, but there are many risk factors you can control with help and advice from a doctor, nurse or dietitian. By making a few changes to your life, you won’t only be doing your heart a big favour but you’ll probably feel a lot better, too. You might start with just one or two of the following suggestions:

Butt out. Smokers are at far greater risk for cardiovascular disease. And smoking rates are significantly higher among PHAs than among the general population. So if you don’t smoke, don’t start! If you do smoke, quitting is the single most important thing you can do to reduce your risk of heart disease. Quitting smoking also reduces your risk of lung disease, cancer, thinning bones and many other health problems.

Once you butt out, your risk for heart disease will diminish as time goes by — it will be cut roughly in half three years after you quit.

Talk to your doctor or nurse for advice about quitting smoking. Nicotine replacements in the form of patches and gum are available. Certain medications and other therapies might also help you quit. Remember that quitting is a process that requires patience and perseverance. For many people, it takes several tries before they’re successful. If you have friends and family members who also smoke, see if one of them will commit to kicking the habit with you.

Eat healthy. Studies have found that eating a diet rich in colourful fruit and vegetables, low-fat dairy products and whole grains can significantly reduce high blood pressure and cholesterol. Eating a handful of nuts (such as almonds, pistachios or walnuts) every day may also help improve your cholesterol levels. Reducing your intake of salt helps to lower blood pressure. And limiting the amount of saturated and trans fats you consume will help keep your cholesterol down.

Ask your doctor or nurse for a referral to a registered dietitian who can give you the advice and support you need.

Bust a move. The “miracle drug” called exercise can help reduce inflammation, lower bad cholesterol levels, help control diabetes and lead to weight loss. Because of these benefits, regular exercise (four or more times per week) can reduce your risk for heart disease. Ideally, your exercise should cause you to break a sweat, make you somewhat breathless and significantly increase your heart rate for at least 30 minutes. Before doing anything more vigorous than walking, talk to your doctor or nurse about what kind of exercise is right for you.

Take it off. If you are overweight or have a large belly, gradually reducing your weight will help lower your risk for heart attacks (see Eat healthy and Bust a move).

De-stress. Easier said than done, but try to keep the stress in your life to a minimum. If avoiding stressful events isn’t possible, acupuncture, massage, meditation, yoga and other relaxing activities can help you cope with stress. And make sure to get plenty of sleep.

Depression seems to increase a person’s risk of heart disease, so let your doctor know if you feel unexpectedly tired or persistently sad or angry. He or she may be able to help or at least refer you to someone who can.

Quit or cut down on substance use. Cocaine, speed, crystal meth and ecstasy can increase your risk of a heart attack. Injecting substances such as heroin or cocaine can also cause serious life-threatening infections, and the resulting inflammation may affect your heart. If you use drugs and want to cut down, speak to a counsellor or someone who can support you.

Practice safer sex. Research suggests that sexually transmitted infections (STIs) heighten your risk for heart disease. Sex can and should be fun but there’s no need to expose yourself to germs. Practicing safer sex, even if you are HIV positive and have sex with other HIV-positive people, helps reduce your risk of catching and passing on STIs. Talk to your doctor about testing for and treating STIs.

Reduce your exposure to germs. Chronic exposure to germs may increase inflammation in your body, which is a risk factor for heart disease. Wash your hands often with soap and warm water. And visit your dentist regularly to maintain your dental health (see “Million-Dollar Smile”).

Because the flu also causes inflammation, if you have heart disease and get the flu, you are at heightened risk for a heart attack. Be sure to get a flu shot every fall.

Can nutritional supplements help? You may have heard about natural health products (vitamins, herbs and supplements) that are supposed to prevent or cure heart disease; unfortunately, there is no such magic bullet. If you do take supplements, let your doctor and pharmacist know what you are taking. Some natural health products can weaken the effects of HIV medications, make the side effects worse or cause their own side effects.

Take heart

Dr. Julian Falutz, director of the HIV Metabolic Centre at the McGill University Health Centre in Montreal, tells his patients: “You can get the most bang for your buck by quitting smoking. Also, find simple ways to be more active in your daily life. Park your car farther away from where you’re going. Stop taking the elevator — climb the stairs instead… You get the idea.

After three months of doing this, you may notice a change: lower blood pressure, lower cholesterol, improved energy, weight loss. The key is to keep it up. Falutz notes that the temptation is to think after a few months: “I’ve done it. I kicked the habit: I’ve quit smoking. I can have one cigarette.” Don’t. Keep it up. The same goes for other lifestyle changes, too.

To empower his patients, Falutz points out that they’ve taken pills (ART) every day — in some cases, for decades — to keep their viral load undetectable. That takes commitment, work and discipline. “Don’t short-change yourself. You can do it.”

Debbie Koenig is a writer/editor at CATIE. This article is based on a CATIE fact sheet written by CATIE science and medicine editor Sean Hosein.

What is heart disease?

Think of your heart as a pump that moves blood through blood vessels to different parts of your body. Heart disease includes a long list of conditions that affect your heart and/or blood vessels, such as heart attack, stroke, aneurysm (the ballooning of a blood vessel) and angina (when an artery that supplies blood to the heart becomes narrowed or blocked and can no longer deliver the blood and oxygen your heart needs).


From The Positive Side

 “Inflammation Information” (Spring/Summer 2010) – an article that explains how chronic inflammation can affect PHAs and may contribute to a range of health problems, including cardiovascular disease

 “Up in Smoke” (Spring/Summer 2004) – an ex-smoker shares practical tips on how to butt out

 “Conquer the Kitchen” (Spring 2008) – an easy-to-read article about healthy eating for people with HIV

 “Let’s Get Physical: The Benefits of Exercise” (Spring/Summer 2005) – a look at how regular exercise can promote the health and overall sense of well-being of PHAs

 “Work It!” (Spring/Summer 2009) – a physician, a dietitian, a yoga instructor and a personal trainer offer advice to PHAs who want to get active

Health Canada’s On the Road to Quitting – a guide to help you in your journey to break free from tobacco

Heart & Stroke Foundation – a wealth of information on heart disease, heart-healthy recipes, educational materials, current research, multicultural resources and more

For more info about HIV and heart health, contact CATIE at 1.800.263.1638 or go to