Patients With HIV Have an Increased Risk of Sudden Cardiac Death

Investigators have found that individuals living with HIV have an increased risk of sudden cardiac death, especially if the virus is not well-controlled or if they have other heart disease risk factors. The findings, published in the Journal of the American Heart Association, add to a list of cardiac risks experienced by patients with HIV.

“People living with HIV are already known to have a higher risk of heart attack, stroke, heart failure, blood clots in the lungs, and peripheral artery disease,” said Matthew S. Freiberg, MD, MSc, the Dorothy and Laurence Grossman Chair in Cardiology and a professor of medicine at Vanderbilt University School of Medicine in Nashville, Tennessee, in a press release. “We know that among people with HIV, those who have a compromised immune system, for example a low total CD4+ T cell count, they seem to have a higher risk of cardiovascular disease than those who have high CD4+ T cell counts. It is unclear if a compromised immune system is a risk factor for sudden cardiac death.”

Sudden cardiac death occurs when the heart unexpectedly stops beating, preventing blood flow to the individual’s vital organs and resulting in death within minutes if untreated. Previous single-center studies have demonstrated that the rate of sudden cardiac death among patients with HIV were 4 times higher than those without HIV. The current study expands the scope to a national scale while also investigating the influence of HIV viral loads and other heart disease risk factors on the risk of sudden cardiac death.

Investigators used data from the Veterans Aging Cohort Study (VACS), an ongoing, long-term, national study that follows veterans with and without HIV, matched by age, sex, race/ethnicity, and the VA site where they receive care. Participants enrolled in the study at an initial medical appointment on or after April 2003, and were followed through December 31, 2014, for the occurrence of sudden cardiac death. Sudden cardiac death was cited as the cause of death for 3035 of the participants during the median follow-up of 9 years, 26% of whom had HIV.

According to the findings of the study, the risk of sudden cardiac death was 14% higher in patients with HIV, 57% higher in patients with HIV whose blood tests showed low levels of CD4+ T cells over time, and 70% higher in patients with HIV whose blood tests showed that antiretroviral therapy had not suppressed the HIV viral load in their blood over time. However, the risk was not significantly higher in patients with HIV who had healthy levels of CD4+ T cells or among those who had a low level of the HIV virus in their blood.

“Addressing risk factors related to both cardiovascular disease and HIV is essential to prevent the higher rates of sudden cardiac death in people with HIV,” said Zian H. Tseng, MD, MAS, Murray Davis Endowed Professor at the University of California, San Francisco, in the release. “Clinicians should consider screening for specific warning signs of sudden cardiac death such as fainting or heart palpitations. And, if indicated, clinicians should request additional testing such as echocardiograms or continuous rhythm monitoring.”

REFERENCE

HIV linked with increased risk of sudden cardiac death [news release]. EurekAlert; September 8, 2021. Accessed September 8, 2021. https://www.eurekalert.org/news-releases/927539