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Heart Disease/Subclinical Heart Disease/Immune Activation/Inflammation....exercise, diet......."Squelching chronic inflammation with diet and exercise is in many ways a no-brainer"
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Jules Levin, NATAP
HIV+ individuals are at greater risk for developing comorbidities: heart disease, kidney disease, bone disease, cognitive impairment/neurologic-brain disease, cancers, and are at risk for developing these diseases at earlier ages than in HIV-negative individuals. Perhaps heart disease is the greatest increased risk for many HIV+ individuals due to HIV & lifestyle considerations. It is suggested by a number of studies & I think generally accepted that the general rule is HIV can accelerate aging by about 10 years in general. Accelerated aging means the immune system declines earlier, at an accelerated pace therefore contributing to greater risk for developing these comorbidities & increasing the risk to develop them earlier. still every individual is different, has different risk factors. At IAS there was an important study finding those with a history or illicit drug use & alcohol abuse were more likely to develop a comorbidity, so if an HIV+ person has a history or currently uses even worse illicit drugs/alcohol this may increase the risk. Genetic or family history matters. Lifestyle matters, one's lifestyle history over many years affects the state of your body's health today: diet & exercise vs sedentary lifestyle. An undetectable viral load is very important & maximizing the CD4 count matter. HIV is associated with inflammation & immune activation so a detectable viral load worsens inflammation & activation, the more virus that is around the worse the risk is. As well diet & exercise reduce inflammation & activation. One can improve immunity, reduce inflammation & immune activation by exercising & good diet despite a prior history of poor lifestyle. You can't eliminate your prior behavior but you can improve your situation today & reduce risks by making healthy lifestyle changes today. Stress & sleep matter. Research shows people who have sleep disorders are more likely to develop some of these comorbidities. Reducing stress can be helpful as well.
CROI/2015: Cardiovascular Disease in HIV Patients: An Emerging Paradigm and Call to Action - (03/02/15)......Steven Grinspoon, M.D., Professor of Medicine, Harvard Medical School.......a key story & message at CROi this year is the risk for sub-clinical heart disease, although this is not a new story since Dr Grinspoon and his group at Mass General have been reporting on this for several years including with publications, this talk includes an update with new information. Of note this problem highlighted by Dr Grinspoon is particularly concerning because the disease is "subclinical" meaning these cardiovascular abnormalities are not detectable by normal lab testing, are below the surface, "subclinical".....At CROI other complications also recd attention including bone disease, cancers, brain & neurologic disease, and renal disease, and again with aging patients these diseases are of increasing risk to patients. The WIHS study reported increased risk for fractures in HIV+ women vs HIV-neg women. The NCI reported "sizeable absolute" increased cancer risks in HIV+ vs HIV-neg, I sent out this report (CROI: NCI sees "sizeable absolute risk" of cancer in elderly with HIV). Of note there are 2 exercise studies at CROI that show improved heart disease risk factors & improved brain volume & brain biomarkers for HIV+.
HIV, Chronic Inflammation, and CVD: Report back from the 2014 Conference on Retroviruses and Opportunistic Infections........Priscilla Hsue, MD Professor of Medicine, UCSF Cardiology Division........http://www.natap.org/2014/CROI/croi_190.htm
CROI/2015: The impact of physical activity on cognition in men with and without HIV.....Higher physical activity category was associated with better scores on tests of psychomotor and executive functioning in a cohort of HIV-infected and -uninfected men at baseline but did not affect the change over time........http://natap.org/2015/CROI/croi_125.htm
"regular physical exercise might serve as an alternative, inexpensive, and safer strategy to combat the detrimental effects of immunosenescence that are caused by frequent viral reactivations......"Aging, Persistent Viral Infections,
and Immunosenescence: Can Exercise ''Make Space''?".......http://www.natap.org/2011/HIV/070411_01.htm
Aerobic Exercise Attenuates Cognitive Decline and Brain Volume Loss Associated With HIV.........http://www.natap.org/2015/CROI/croi_107.htm............aerobic exercise improved cognition, increased brain volume.....a 50 yr old HIV+ who exercises has same brain volume as sedentary 40 yr old HIV+, exercise prevents decline with aging
Running for an hour or more per week lowers a man's risk of developing heart disease by 42 percent, according to the Journal of the American Medical Association (Oct. 23, 2002).......Aim for 30 minutes daily of moderate physical activity, such as walking, running, swimming or even yard work......."Mental states are important," says Meggs. "We know that angry, hostile people have higher CRP levels than people who keep their cool."......squelching chronic inflammation with diet and exercise is in many ways a no-brainer........Exercise also may directly muffle inflammation. In studies, both aerobic and nonaerobic exercise have been shown to lower levels of C-reactive protein, or CRP (the body's marker for inflammation). The lower the body's CRP, the less inflammation is present.......A diet high in trans-fatty acids, carbohydrates and sugar drives the body to create inflammatory chemicals. On the flip side, a diet heavy on vegetables, lean meats, whole grains and omega-3 fatty acids puts the brakes on the inflammatory process......Recent research indicates that inflammation plays either a leading or supporting role in many of the most common types of cancer - colon, stomach, lung and breast......Most foods either rev up inflammation or tamp it down. A diet high in trans-fatty acids, carbohydrates and sugar drives the body to create inflammatory chemicals. On the flip side, a diet heavy on vegetables, lean meats, whole grains and omega-3 fatty acids puts the brakes on the inflammatory process......Fruits and vegetables are storehouses of antioxidants and other anti-inflammatory compounds......http://www.natap.org/2011/newsUpdates/052611_07.htm
The Effect of Physical Activity on Cardiometabolic Health and Inflammation in HIV......http://natap.org/2015/CROI/croi_108.htm......Physical activity is independently associated with insulin resistance, vascular disease and endothelial function......physical activity was independently associated with insulin resistance and with several markers of markers of cardiovascular disease.....over the 96 week study period, exercise was associated with multiple measures of subclinical vascular disease, suggesting that exercise in HIV-infected patients may improve vascular structure as well as function
"Exercise is Nonpharmacological Intervention To Reduce Inflammation...prevent metabolic diseases" Taming HIV-Related Inflammation with Physical Activity: A Matter of Timing Physical Activity and Inflammation.........http://www.natap.org/2014/HIV/102914_02.htm.....It is well established that in healthy individuals, regular aerobic exercise of moderate intensity and duration is associated with a reduced incidence of metabolic diseases. In addition, exercise reduces the excess storage of fat in adipocytes and their production of inflammatory mediators, thus limiting the inflammation associated with obesity.47 Indeed, regular aerobic exercise reduces inflammation in diseases associated with low-grade inflammation (e.g., obesity, chronic heart failure, atherosclerosis, diabetes).48,49 While the protective antiinflammatory effect of physical exercise is well documented, there is also evidence that physical inactivity may favor the development of low-grade systemic inflammation. This is due to the fact that sedentary behavior leads to the accumulation of visceral fat, which is accompanied by increased release of adipokines and adipose tissue infiltration by proinflammatory immune cells. This negative interplay between immune and metabolic dysfunction is associated with the development of insulin resistance, atherosclerosis, and neurodegeneration.50-52 For these reasons, there is growing interest in studying the effects of physical activity as a nonpharmacological tool to reduce chronic inflammation, even though the mechanisms responsible for this immune modulatory effect remain poorly understood.
Mediterranean Diet Improves Health & Mortality......"reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%), and incidence of Parkinson's disease and Alzheimer's disease (13%). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.".......http://www.natap.org/2008/AGE/091708_03.htm
Mediterranean Diet Shown to Ward Off Heart Attack and Stroke[by 30%] [exercise too] -new study......http://www.natap.org/2013/newsUpdates/022713_01.htm ........- see full text below following NY Times article: "Primary Prevention of Cardiovascular Disease with a Mediterranean Diet" in New England Jnl of Medicine see full text below -- "olive oil, fruit, nuts, vegetables, and cereals; a moderate intake of fish and poultry; a low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation, consumed with meals.......In this trial, an energy-unrestricted Mediterranean diet supplemented with either extra-virgin olive oil or nuts resulted in an absolute risk reduction of approximately 3 major cardiovascular events per 1000 person-years, for a relative risk reduction of approximately 30%, among high-risk persons who were initially free of cardiovascular disease" AND EXERCISE REDUCES INFLAMMATION/ACTIVATION, slows aging process........
Mediterranean Diet/Nuts/Olive Oil Improve Brain Function......http://www.natap.org/2015/HIV/070815_02.htm
Myocardial infarction in relation to mercury and fatty acids from fish: a risk-benefit analysis based on pooled Finnish and Swedish data in men.....http://www.natap.org/2012/newsUpdates/AmJClinNutr-2012Wennberg-706-13.pdf
Impaired Cardiac Strain and Biomarkers of Immune Activation in HIV/16th International Workshop on Co-morbidities and Adverse Drug Reactions in HIV 6 October 2014........Strain indices of systolic dysfunction were decreased in HIV-infected subjects. Further, subclinical impairment in systolic function was associated with markers of chronic immune activation. Similar to patients with chronic heart failure, increased levels of MCP-1, a chemokine important in the regulation of monocyte and macrophage migration and a marker of immune activation, was strongly associated with impairment in cardiac function. LBP, an acute phase protein made in response to lipopolysaccharide (LPS), was also associated with impaired cardiac strain in the HIV-infected cohort. Our findings indicate that subclinical impairment in cardiac strain tracks with markers of chronic inflammation and immune activation, which may serve as targets for future therapeutic strategies to optimize long-term cardiovascular health in persons living with HIV.........http://www.natap.org/2014/IWCADR/IWCADR_02.htm
Diet, Dementia, Cognitive Impairment, Diabetes Intersect......http://www.natap.org/2014/HIV/040314_02.htm
CROI/2015: Impaired Cardiac Strain and Biomarkers of Immune Activation in HIV........http://www.natap.org/2015/CROI/croi_129.htm......Conclusions: HIV-infected subjects demonstrate subclinical impairment in systolic function and this is associated with markers of chronic immune activation, inflammation and tissue remodeling. Similar to patients with chronic heart failure, increased levels of MCP-1, a chemokine important in the regulation of macrophage migration and a marker of immune activation, was a strong independent predictor of impairment in cardiac function. LBP, an acute phase protein made in response to LPS, and TIMP-1, a marker of tissue remodeling, were also associated with impaired cardiac strain. Our findings indicate that subclinical impairment in cardiac strain tracks with markers of chronic inflammation and immune activation, which may serve as targets for future therapeutic strategies to optimize long-term cardiovascular health in persons living with HIV.
Subclinical Heart Dysfunction/Belly Fat.....Our study identified increased subclinical cardiac dysfunction in association with cardiac steatosis and fibrosis in HIV-infected adults......Our findings strongly suggest that diffuse, rather than focal myocardial injury, may be the sequelae of HIV infection and myocardial steatosis......"visceral adiposity in HIV-infected individuals may increase the risk for clinical cardiac dysfunction through cardiac steatosis.".......To investigate the potential relationship between subclinical cardiac dysfunction and myocardial lipid and fibrosis, this study evaluated subjects with a broad range of exposure to HIV and its therapies, but without clinical cardiovascular disease. Despite normal ejection fraction, we identified significantly reduced systolic function (27% relative reduction in radial strain), greater intramyocardial lipid content (by 38%), and evidence of diffuse myocardial fibrosis (by 8%) in HIV-infected individuals compared to age, sex, and race-matched controls. Impaired myocardial function as measured by strain parameters was associated with increased myocardial lipid and fibrosis in this cohort......http://www.natap.org/2015/HIV/060815_01.htm.......Methods. Cross-sectional study of 95 HIV-infected and 30 matched-healthy adults, without known cardiovascular disease (CVD) was completed. Intramyocardial lipid, myocardial fibrosis, and cardiac function measured by strain were quantified by MRI........Conclusions. HIV-infected adults have reduced myocardial function compared to controls in the absence of known CVD. Decreased cardiac function was associated with abnormal myocardial tissue composition characterized by increased lipid and diffuse myocardial fibrosis. Metabolic alterations related to antiretroviral therapy and chronic inflammation may be important targets for optimizing long-term cardiovascular health in HIV.......Monocyte chemoattractant protein-1 (MCP-1) is a chemokine important in monocyte and macrophage migration and is a marker of chronic inflammation and immune activation. In patients with chronic heart failure, elevated MCP-1 levels are associated with decreased left ventricular ejection fraction and, in one study, higher MCP-1 levels predicted subsequent cardiac events [32]. We found that increased MCP-1 levels were strongly associated with degree of impairment in cardiac strain.......Prospective longitudinal studies evaluating these characteristics in patients initiating ARVs, as well as studies with clinical cardiovascular disease endpoints are needed to fully appreciate the etiology and significance of cardiac steatosis, fibrosis, and impaired cardiac strain in HIV. Females were relatively underrepresented in the study population. Further studies focusing on cardiovascular disease in women are needed to better examine the relationship between HIV infection and cardiac steatosis.
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