heart health for plhiv: some directions
DESCRIPTION
This presentation was given by Sean Slavin (NAPWA) at the AFAO HIV Educators Conference 2010.TRANSCRIPT
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Heart health for PLHIV: some directionsSean Slavin
Assistant Director (Research Programs)
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Impact of long-term living with HIV
• Increased morbidity & mortality due to non-AIDS illnesses• Traditional risk factors - lifestyle, family
history.• HIV + ART lead to some co-morbidities• Aetiology is currently debated• Many of the risk factors are the same as for
the general population.
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Cardiovascular disease (CVD), Coronary Heart Disease (CHD)
and Myocardial Infarction (MI - Heart Attack)
Terms
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Cardio Vascular Disease, Coronary Heart Disease & Myocardial Infarction
• What are the rates among PLHIV?
• What are the risks?
• How do these compare to general population risks?
• What can be done?
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Triant, V. A. et al. J Clin Endocrinol Metab 2007;92:2506-2512
Myocardial infarction rates and corresponding adjusted RR
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INTERHEART:Risk of AMI with Multiple
Risk Factors
Smk DM HTN APoB/A1+2+3 all4 +O +PS All RFs
2.9 2.4 1.9 3.3 13.0 42.3 68.5 182.9 333.7
1
2
4
8
16
32
64
128
256
512
OR
(9
9%
CI)
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Summary
• Increased life expectancy
• Risk of CVD important but has complex aetiology not completely understood (CD4 and certain drugs)
• Dyslipidemia may be HIV, ART or lifestyle related
• Conventional risk factors including lifestyle factors likely to be more significant and occur at higher rates in HIV+ population irrespective of cause
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Risks – what we can influence
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For HIV+ health promotion…
• There is much that can be done but no silver bullet
• Lifestyle risks can be reduced – there is a wealth of experience to draw on esp. mainstream health promotion agencies.
• Remain cognisant of the social determinants – poverty, stigma, homophobia
• Don’t cede all the ground to the medical profession
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What are the targets
• BMI < 25
• Waist circumference < 94cm
• Cholesterol
• Blood pressure
• Improve psycho/social functioning
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How do we achieve these goals?
• Exercise – at least 30mins a day
• Weight loss
• Stop smoking
• Reduce alcohol intake
• Diet – healthy eating overall but particularly reduce sodium intake
• Mental health – esp.depression
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Social Context
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Thankyou