Higher Risk of Sudden Cardiac Death in People with HIV

United States veterans who have HIV were shown to have a 14% higher risk of sudden cardiac death (SCD) compared to veterans who did not have HIV. The increased risk of SCD was 57% to 70% higher in veterans who had high HIV viral loads and was 50% higher for each additional heart disease risk factor they had.

“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,” Matthew Freiberg, MD, MSc, lead author of the study, the Dorothy and Laurence Grossman Chair in Cardiology and a professor of medicine at Vanderbilt University School of Medicine in Nashville, Tennessee, said. “It is unclear if a compromised immune system is a risk factor for sudden cardiac death.”

The study was published in the Journal of the American Heart Association.

The study was designed to investigate the role of HIV, HIV disease status, and other health conditions. The investigators evaluated participants from a national study of people with HIV infection that has a matched participant group without HIV: the Veterans Aging Cohort Study (VACS). The VACS is an ongoing, prospective, observational, longitudinal study that follows veterans with and without HIV (there are 2 uninfected to each 1 HIV-positive participant), and matched by age, sex, race/ethnicity and the veterans administration (VA) site where they receive care.

Among the more than 144,000 veterans in the VACS study, 30% were diagnosed with HIV and evaluated at VA hospitals in the US. Study participants were 97% male, 47% were African American, and the average age was 50 years at enrollment. Each participant entered the study at an initial medical appointment on or after April 2003, and were followed through December 31, 2014, for the occurrence of SCD. During the median follow-up (9 years), sudden SCD was cited in 3035 of the veterans, and 777 (26%) were HIV-positive.

Clinical Considerations

“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,” Freiberg said.

As such, clinicians may want to screen these patients, especially if they are exhibiting certain symptoms.

“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,” Zian H. Tseng, MD, MAS, senior author of the study and a professor of medicine in residence, Murray Davis Endowed Professor at the University of California, San Francisco, said. “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.”