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Cardiovascular Disease: Predicting Risk and Monitoring Outcomes Monica R. Shah, MD, FACC

Cardiovascular Disease: Predicting Risk and Monitoring Outcomes Monica R. Shah, MD, FACC NHLBI AIDS Coordinator Conference on Retroviruses and Opportunistic Infections March 5, 2013. Overview. HIV-Related Cardiovascular Disease (CVD)

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Cardiovascular Disease: Predicting Risk and Monitoring Outcomes Monica R. Shah, MD, FACC

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  1. Cardiovascular Disease: Predicting Risk and Monitoring Outcomes Monica R. Shah, MD, FACC NHLBI AIDS Coordinator Conference on Retroviruses and Opportunistic Infections March 5, 2013

  2. Overview • HIV-Related Cardiovascular Disease (CVD) • NHLBI AIDS Working Group (WG) – Scientific Priorities • NHLBI AIDS Program – Future Initiatives

  3. AIDS – An Evolving Population AIDS Patients Face Downside of Living Longer January 2008 • In the US ~1.2 million people living with HIV; 50,000 new infections each year • By 2015, HIV patients aged 50 and older will account • for >50% of HIV/AIDS cases1 • Chronic, non-infectious diseases such as CVD increasing public health problem 1www.cdc.gov; Slide courtesy P. Hsue

  4. HIV-related CVD – Significant Mortality • 1,876 deaths among 39,727 patients • Non-AIDS related deaths accounted for 50.5% • ~16% were due to CVD Renal 3% Other 9.0% Respiratory 3.1% 13 HIV Cohorts 1996-2006 Non-AIDS Malignancy 23.5% Liver-related 14.1% Non-AIDS infection 16.3% Violence, Substance abuse 15.4% CVD 15.7% Antiretroviral Therapy Cohort Collaboration. Clin Infect Dis. 2010;50:1387-1396 Slide courtesy JS Currier

  5. Risk of CVD in HIV vs. Non-HIV Patients HIV – no ART RR 1.61 (1.43-1.81) p<0.001 HIV – on ART RR 2.0 (1.7-2.37) P<0.001 Islam, FM, et al. HIV Medicine; 2012; 13:453-68.

  6. HIV-Related CV Disease • Complex interplay between • Conventional risk factors • Higher rates of smoking, dyslipidemia, hypertension, diabetes • Obesity • Renal disease • Cardio-metabolic adverse effects of ART • HIV infection • Inflammation and Immune Activation

  7. Inflammation and Immune Activation HIV Infection Gut microbiome Aging Hypercoagulability Hsue, P et al. The Journal of Infectious Disease. 2012; 13: S375-82.

  8. HIV-Related CV Disease • Coronary artery disease • Arrhythmias and sudden cardiac death • Heart failure • Pulmonary hypertension • Hypertension/vascular disease

  9. NHLBI AIDS Program – Mission The NHLBI AIDS Program provides global leadership for research, training, and education programs to promote the prevention and treatment of HIV-related cardiovascular, pulmonary, and hematologic disease. The NHLBI AIDS Program believes that critical research in this area will result in discovery that enhances the survival and quality of life of patients with HIV, and may also lead to knowledge that benefits all patients with heart, lung, and blood disease.

  10. NHLBI AIDS WG: CV Scientific Priorities

  11. HIV/AIDS WG: CV Scientific Priorities

  12. NHLBI AIDS WG: CV Scientific Priorities

  13. NHLBI AIDS WG: Research Strategies • Multi-disciplinary collaboration • Critical need for HIV and CV researchers to work together to advance field • Leverage existing research resources • Cross-institute collaboration • Training • Training programs that allow clinical and basic investigators to learn fundamentals of HIV & CVD research

  14. NHLBI Future Initiatives – Goal 2014 • Focus on scientific gaps identified by WG • Broadly stimulate science • Promote multi-disciplinary collaboration • Encourage peer-review, investigator-initiated research • Educate scientific community that NHLBI is a primary Institute for AIDS research

  15. Conclusion • Increasing focus on HIV-related CVD • Progress in science • NHLBI uniquely poised to support research in this area

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