This Valentine’s Day, Be Good to Your Heart

With St. Valentine’s Day just around the corner, let’s turn our thoughts to hearts. No, not those gaudy foil-wrapped heart-shaped boxes filled with chocolate decadence that fill aisle after aisle at CVS or Walgreens, nor those treacly sentimental greeting cards that crowd up shelves in every grocery store or drugstore and end up shoved into some drawer at home. I mean our hearts — those powerful, vulnerable organs in our chests that thump-thump along pumping blood throughout our bodies. Those hearts. Specifically, the hearts of us long-term HIV survivors whose HIV-ravaged bodies are prone to so many comorbidities, including cardiovascular diseases.

As highly active retroviral treatment has increased the life expectancy among individuals ageing with HIV, so HIV-associated cardiovascular diseases have become more common. As if our hearts hadn’t already been emotionally battered for years…

What we know now: Among the many comorbidities that can afflict people ageing with HIV, cardiovascular diseases are perhaps the deadliest. Studies with large cohorts have demonstrated that, compared with people without HIV, we long-term survivors face a fifty-percent (50%) higher risk of many forms of cardiovascular disease, including myocardial infarction, heart failure, pulmonary inflammation, hypertension, and others, as well as a slightly increased risk of stroke. In the early years of study of the relationship between HIV and increased susceptibility to heart disease, it was thought that the medications used to control HIV contributed to that increased risk. However, recent data indicate that the link is more attributable to HIV viremia (i.e., uncontrolled spread of the virus) and low CD4 counts.

Other factors that exacerbate the link between HIV and cardiovascular disease include increases in dysfunctional subcutaneous fat and visceral fat — i.e., that “spare tire” or “middle-age spread” we are prone to as we age. These changes in body fat are closely associated with atherosclerotic plaque — hardening of the arteries — which can lead to cardiovascular disease. And although newer HIV medications are less likely to cause such problems, we long-term survivors are more likely to have taken older HIV drug regimens associated with body shape changes (lipodystrophy; “hard belly”) and increased blood fats, which are linked to heart disease. Researchers have posited that excess belly fat increases our risk of heart attack by twenty-six percent (26%) or more.

Of course, there are non-HIV-specific factors that contribute to cardiovascular disease in long-term survivors. For instance, surveys have shown that people living with HIV who smoke cigarettes are at a significantly higher rate than those who are HIV-negative; thus, the risk of myocardial infarction attributable to smoking is considerably higher for individuals living with HIV than those without. It is also believed that high alcohol consumption may also contribute disproportionately to HIV-associated cardiovascular disease, to say nothing of the effects abnormally high use of other substances.

At the risk of being thought some “Debby Downer” dispensing unwanted medical advice, I can share with you the common-sense, non-medical advice that applies to both HIV-positive and -negative individuals concerned with their heart health:

• If you smoke cigarettes, STOP. The harmful effects of smoking tobacco begin to diminish when you smoke your last cigarette.
• If you regularly drink to excess, STOP. We all enjoy a cold crisp white wine with dinner or a shot of tequila when the 49ers score a touchdown, but excessive drinking can damage your heart.
• Trust me, I know that quitting cigarettes and curbing our drinking habits are not easy to do. Been there, done that a few times and have sometimes back-slid on both. But for the sake of your heart, both are worth the effort it takes. Give it your best shot!
• Eating a healthy diet low in saturated fats can help prevent the accumulation of plaque that clogs your arteries.
• Exercise regularly. Get up off the couch and get outside; walk around this beautiful walkable city; go dancing with friends; get that tennis racket out of the closet and start using it again; take the stairs instead of the escalator. Even moderate exercise can help to strengthen your heart and ward off cardiovascular problems. Taking control of your health can dramatically reduce your susceptibility to many comorbidities, including cardiovascular diseases, and thus increase the length and the quality of your life.

This St. Valentine’s Day, let’s all re-commit to living our best, healthiest lives. It starts with caring for your heart. Do it for yourself — and for all the other hearts that your life touches.