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SAN FRANCISCO – Physicians treating HIV patients may need to be more alert to the early signs of cardiovascular disease, researchers said here.

People with HIV were more likely than others to already have serious coronary artery disease by the time they were given cardiac catheterization, according to Charles Hicks, MD, of Duke University Medical Center.

The finding, from a small cohort study, suggests that HIV specialists may be missing the early signs of cardiovascular illness in their patients, Hicks told reporters at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

He and colleagues studied 96 people with HIV who were referred for cardiac catheterization and compared them with 41 matched controls from general medicine clinics who were also undergoing a first cardiac catheterization.

"A significantly higher proportion of those cared for in the HIV clinic at the time of catheterization either were having a myocardial infarction or were having unstable angina," he said.

Specifically, 54% of the HIV patients were having either a heart attack or unstable angina, compared with 34% of the general medicine patients (P=0.04).

The finding suggests that the HIV specialists who were treating those patients had missed earlier opportunities to diagnose the incipient heart problems, Hicks said.

The study is one of two presented here suggesting that HIV may have an adverse impact on heart health. In the second study, a retrospective database analysis of about 2.8 million acute myocardial infarction patients over a 10-year period, researchers found that HIV was associated with nearly a 40% increase in the risk of dying in hospital after the attack.

Data from the National Inpatient Survey for the years 1997 through 2006 showed that – even after adjustment for a range of variables – 4% of those with HIV died of their heart attack, compared with 2% of those who were HIV-negative, according to Daniel Pearce, DO, of Loma Linda University in Loma Linda, Calif.

After adjustment for a host of factors, including the type of hospital, number of comorbidities, and number of procedures performed, those with HIV had a hazard ratio of 1.38 for death (P<0.05).

Exactly why the difference occurred remains unclear, Pearce said, noting it could be an unconscious bias among healthcare providers that leads to worse care, something related to the HIV infection itself, or an effect of the drugs HIV patients take to control the virus.

"We need to investigate why that is," he said.

Interestingly, he noted, typical heart attack care procedures occurred at significantly lower rates among HIV-positive patients. For instance, 48% of HIV-positive patients had coronary arteriography compared with 62.5% of HIV-negative patients, and 6% had a coronary artery bypass graft compared with 13.8% who were HIV-negative.

Taken together, Pearce said, the two studies suggest that healthcare providers who treat HIV patients need to be "more alert" to early signs and symptoms of heart disease.

Two practical measures to improve matters, Pearce said, might be early electrocardiograms and a lower threshold for starting low-dose aspirin.

One surprising finding in the first study was the difficulty of finding enough control patients, according to lead author Christy Kaiser, MD, now of Georgetown University in Washington.

The HIV patients had a median age of 49 and had been in care long enough to have had at least three visits to the clinic before referral to the cath lab.

But, Kaiser said, the researchers had to exclude three-quarters of their potential controls because they were either too old or – if they were in the right age group – had not been under a doctor's care for long.

Younger men of lower socioeconomic class typically "don't go to the doctor," she said. But those with HIV do, so that "ideally, we should really be catching (cardiovascular) disease earlier."

In contrast to the database study, Hicks said, patients in his study got similar care after the cardiac catheterization.