Burden of cardiovascular risk factors in stable HIV patients aged 50 years old and above

Abstract

Background: Advancement in HIV treatment has revolutionized the disease from being an infection with high mortality to a chronic illness. As the PLHIV population ages, we foresee increasing number of patients suffering from dyslipidemia, diabetes mellitus or hypertension that will eventually increase their risk of cardiovascular disease. Methods and materials: The objectives of this study was to stratify the cardiovascular risk factors and determine the prevalence and control of these risk factors. This study was performed at a referral HIV/AIDS clinic in Klang Valley, Malaysia. The cohort studied patients who started follow-up from 2007 till 2015. Patients aged ≥50 years with HIV viral suppression of ≥2 years were included in the study. Definitions of dyslipidemia, hypertension and risk stratification of cardiovascular risk were based on the latest Malaysia clinical practice guidelines. Results: A total of 635 patients were included in the study. Majority of them were male (83.8%), Chinese (56.1%) with heterosexual (60%) as their main modes of transmission. The prevalence of LDL-C dyslipidemia, hypertension and diabetes mellitus were 71%, 38% and 18% respectively. While 52.3% of them belonged to intermediate cardiovascular risk group, almost one third (32.8%) fell under high and very high cardiovascular risk group. Overall, 67.2% of hypertensive patients and 65.9% of patients with LDL-C dyslipidemia did not achieve their target while on treatment. Based on regression analysis, factors associated with poor LDL-C control include younger age, lower CD4 count, higher systolic blood pressure, homosexual, and diabetes mellitus. There are no significant predictors for poor hypertensive control in our cohort of patients. Conclusion: With the high prevalence of these cardiovascular risk factors, emphasis on cardiovascular risk stratification and aggressive control of these risk factors based on respective treatment target is imperative to reduce their cardiovascular morbidity and mortality.