Page 27 - Delaware Medical Journal - March/April 2020

RESEARCH
There is no difference in terms of the risk posed by individual risk factors like tobacco use, high cholesterol, diabetes, and hypertension, but
the cumulative effect is causing a significantly higher risk, as seen by
the difference in the Framingham risk between the two groups (Table 2).
This shows that established risk factors themselves play a more significant
role in HIV-associated CAD than HIV itself.
However, according to the results from our study, there is no difference in the health behavior of the HIV- infected women (Table 3). Physicians and healthcare providers seem to be more sensitive in this regard and they did advise their HIV patients to focus on exercise and diet modification. However, it is not clear whether this pattern is coincidental or related to the fact that they are HIV-positive.
Since HIV seems to be an independent risk factor for developing CAD, it is prudent to sensitize both physicians and patients regarding the increased
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vulnerability to CAD in the HIV- positive population. HIV-positive women should be provided relevant information regarding smoking cessation, lifestyle modifications, periodic blood pressure and lipid- profile monitoring, and diabetes screening. The evidence-based public health strategies that are currently in practice targeting traditional CAD risk factors for the general population should be further tailored to HIV- infected patients.
The biggest strength of our study
is using national-level data, a large number of variables, and a large sample size. To the best of our knowledge,
this is the first and the only study that has evaluated the cardiovascular risk patterns in women with HIV.
This study is not without limitations. The study has a very small number
of HIV-positive patients. It is a retrospective study based on self- reported data from the CDC/NHANES survey. Studies have shown that self- reported data varies in reliability. The
data collection was not done in a blind pattern. More detailed information that may affect cardiovascular risk, such
as HIV viral load and compliance with HIV medications, was not available. The Framingham risk score does not take into account higher levels of high-sensitivity C-reactive proteins, which may be reflective of increased cardiovascular risk, particularly in women.
CONTRIBUTORS
■ SRIKRISHNA VARUN MALAYALA, MD, MPH, FHM, FACP is a hospitalist at Bayhealth Sussex Campus in Milford. He has a Master’s in Public Health from Western Kentucky University and fellowships from the Society of Hospital Medicine and American College of Physicians. He is the Chair of the Medicine Department at Bayhealth Sussex Campus in Milford, Delaware.
■ AMBREEN RAZA, MD graduated from the Internal Medicine program at the University at Buffalo and from Cooper University Infectious Diseases. She practices in Milford, Delaware.
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