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Cardiovascular disease (CVD) refers to a group of diseases and illnesses of the heart and blood vessels and includes:

• coronary arteryOne of the two arteries that supply the heart with oxygenated blood. disease (narrowing of the arteries that supply blood to the heart, which can lead to chest pain [anginatemporary chest pain or a sensation of pressure due to a lack of oxygen supply to the heart. Also called angina pectoris.] or heart attacks)
• cerebrovascular disease (strokes and other problems with blood vessels in the brain)
• hypertension (high blood pressurePersistently high blood pressure, an outwardly symptomless condition which carries an increased risk of serious illnesses such as stroke, heart disease and heart attack.)
• peripheral vascular disease (blocked blood vessels in the legs).

Changes in blood lipids (fats) are associated with both HIV infection and ARVA medication or other substance which is active against retroviruses such as HIV. treatments and with increased risk of cardiovascular disease. Both HIV infection and ARV treatment can change the cholesterolAn essential component of cell membranes and nerve fibre insulation, cholesterol is important for the metabolism and transport of fatty acids and the production of hormones and Vitamin D. Cholesterol is manufactured by the liver, and is also present in certain foods. High blood cholesterol levels have been linked to heart disease and may be a side effect of some anti-HIV medications. levels in your blood and increase the risk of cardiovascular disease.

Low density lipoprotein (LDL) is also known as bad cholesterol because it can add to the build up of plaqueA sticky substance that forms on the surface of the teeth, helping bacteria growth and acid formation beneath its surface, and causing tooth decay. Plaque build-up can irritate the gums and cause gum disease. Removal of plaque through regular brushing and flossing is the key to good oral hygiene. in your arteries and increase your risk of getting coronary heart disease.

High density lipoprotein (HDL) is also known as good cholesterol because it helps to protect you against coronary heart disease.

As people with HIV live longer, cardiovascular disease is becoming an increasingly significant problem for people with HIV. It is now perhaps one of the most common causes of death for people with HIV.

The original goal of HIV management was to target the HIV virusA small infective organism which is incapable of reproducing outside a host cell. itself, and thus reduce HIV viral loadA measurement of the quantity of HIV RNA in the blood. Viral load blood test results are expressed as the number of copies (of HIV) per milliliter of blood plasma. to undetectable levels. However, as awareness of the increasing problem of cardiovascular disease has grown, many doctors now describe an important secondary goal in HIV management is to try to reduce the risk of cardiovascular disease in people with HIV.

There are many risk factors for cardiovascular disease.
They include:

• smoking (tobacco and marijuana)
• excessive alcohol consumption
• amphetamine use
• high blood pressure
• poor diet
• insufficient physical activity
• obesity and abdominal fat accumulation (as measured by waist circumference and your BMI [body mass index])
• blood lipid abnormalities, for example,
• high total cholesterol (> 5.2 mmol/L)
• high LDL (>4 mmol/L)
• low HDL (<1.0 mmol/L)
• high triglycerides (> 2.0 mmol/L)
• impaired glucose metabolism
• insulin resistanceA diabetes-like condition in which, while adequate amounts of insulin are produced by the pancreas, the body does not respond normally to the action of insulin. In the wider community, insulin is related to obesity, while in HIV it may be related to lipodystrophy.
• diabetes[Diabetes mellitus] A disorder in which sugars in the diet cannot be metabolised into energy due to a lack of the enzyme insulin. Late-onset diabetes mellitus may be a long-term side effect of some anti-HIV drugs. (fasting glucose >7 mmol/L).

The risk factors identified above however are ones that you can change through appropriate treatment or by making lifestyle changes.

However, risk factors that you can’t change include:

• older age (>45 for males and >55 for females)
• male gender (women tend to lose any protection from CVD once they become post-menopausal)
• being HIV positive
• family history of CVD.

Some ARV treatments are associated with changes to blood lipids (fats) and some of the older HIV drugs increased the risk of diabetes—both of which increase the risk of cardiovascular disease.

Studies show that HIV measurably adds to cardiovascular risk if you also have other risk factors present, but without these other risk factors being present the impact of HIV on increased risk is far less noticeable.

This is why increasing attention in the care and treatment of all people with HIV also focuses on preventing cardiovascular disease.

Ahead of Time: A practical guide to growing older with HIV

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