A comparative analysis of cardiovascular risk in HIV sero-positive and sero-negative pre-menopausal women

Background: HIV infection has been associated with an increased risk of cardiovascular disease (CVD), stroke, and subclinical atherosclerosis in women. HIV positive pre-menopausal women tend to lose the cardio-protective effect of estrogen and these women should be more vigilant in reducing their risk for developing CVD. Our study intends to assess the cardiovascular risk in the HIV positive pre-menopausal women over the last sixteen years (1999-2014) using a national wide sample.

Methods: This study is a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) datasets from 1999 to 2014. The 10-year Framingham risk score for developing CAD was calculated for the HIV positive and HIV negative pre-menopausal women. The individual risk factors contributing to CAD including blood pressure, hemoglobin A1c, c-reactive protein (CRP), smoking status, cholesterol level, family history of CVD were compared. The populations’ intent to reduce their risk (exercise, diet modification and use of medications) and their doctor’s advice to reduce the risk (counseling on diet, exercise and weight) were also analyzed. SPSS v.19 was used for analysis and p-value < 0.05 was considered significant.

Results: Out of the available sample of 82091 people, 9635 women (11.7%) met the inclusion criteria (pre-menopausal women, 18 to 55 year old, no prior history of CAD, no missing data and tested for HIV). Among them, 25 women were HIV seropositive (0.25%). Though there was no significant difference in the systolic and diastolic blood pressure, HbA1c, CRP, HDL or total cholesterol (p-value>0.05); the mean Framingham risk score in pre-menopausal HIV positive women (M=2.12, SD=2.73) was significantly higher than the HIV negative women (M=0.95, SD=1.94); p-value<0.01. Neither did majority of the HIV positive women intend to decrease their cardiovascular risk nor did their health care providers advice them to do so.

Conclusion: This study shows that the risk of developing CVD in pre-menopausal women seems to be higher from the traditional risk factors itself. While HIV is now independent risk factor for developing CVD in women, more focus should be on reducing the risk from traditional methods like smoking cessation, diet and life style modification, blood pressure, diabetes and cholesterol and management.