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Sex-Differences in Atherosclerotic Cardiovascular Disease
Risks and Mechanisms among People with HIV:
Insights from REPRIEVE
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CROI 2024 March 3-6 Denver
• CROI: Performance of the ACC/AHA Pooled Cohort Equations or Risk Prediction in the Global REPRIEVE Trial - (03/16/24)
• CROI: Factors Contributing to Risk of Major Adverse Cardiovascular Events among People with HIV in REPRIEVE - (03/16/24)
• CROI: Pitavastatin Reduces Non-Calcified Plaque via Pro-Collagen PCOLCE Independently of LDL in REPRIEVE - (03/16/24)
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In the general population, the ACC/AHA Score does NOT include any HIV-related measures including systemic immune activation & inflammation. Women have lower risk scores than men using these score Guidelines (5.1% vs 2.2%). Based on the Triant data "we may wonder whether baking into the calculation a protective effect of female sex for PWH ling in the USA". In REPRIEVE, median 20-year ASCVD risk score was significantly lower for women than men (1.9% vs 5.4%).
Yet, despite women having lower ASCVD risk scores, among women estimated MACE rates tended to be higher among those with ASCVD risk scores above 2.5 compared to men. Also of note as risk scores increased, worsened estimated MACE rates increased reflecting that traditional risk factors are relevant for PWH.
10-year ASCVD significant underestimated risk among women with HIV in high income countries. Rates of observed events for higher for women than men - see table below.
'Females sex was NOT protective in REPRIEVE for HV+ as it was in HIV-negative women.'
CDC - Over 60 million women (44%) in the United States are living with some form of heart disease.2 Heart disease is the leading cause of death for women in the United States and can affect women at any age. In 2021, it was responsible for the deaths of 310,661 women—or about 1 in every 5 female deaths.1 Research has shown that only about half (56%) of US women recognize that heart disease is their number 1 killer.3 -
Risk Factors for Heart Disease in Women - CDC -
The Centers for Disease Control and Prevention (CDC)Trusted Source report that heart disease is the leading cause of death for females in the United States. However, only 56% are aware of the risk.
High Blood Pressure (Hypertension)
• High blood pressure is a major risk factor for heart disease. More than 56 million women in the United States (44.3%) have high blood pressure (defined as 130/80 mm Hg or higher) or are taking blood pressure medicine5. This includes almost 1 in 5 women of reproductive age.6
Several other medical conditions and lifestyle choices can put women at higher risk of heart disease,4 including:
• High LDL (low-density lipoprotein) cholesterol
• Smoking
• Diabetes
• Excess weight
• An unhealthy diet
• Physical inactivity
• Drinking too much alcohol
• Stress and depression
CID - Sex Differences in Subclinical Atherosclerosis and Systemic Immune Activation/Inflammation Among People With Human Immunodeficiency Virus in the United States – pdf attached
SUBCLINICAL ATHEROSCLEROSIS AND IMMUNE ACTIVATION AMONG US FEMALES VS MALES WITH HIV
- women have more immune activation
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