What started as a casual observation among physicians almost a decade ago—that patients with HIV tend to develop hypertension and have a greater risk of heart attacks than the general population—has become a formal area of study and treatment within the Mount Sinai Health System.
Under the direction of Merle Myerson, MD, EdD, Director of the St. Luke’s Roosevelt Center for Cardiovascular Disease Prevention, and Director of the Cardiology Section of the Spencer Cox Center for Health, patients with HIV are being closely monitored and treated for heart disease and stroke. In fact, cardiovascular care has become increasingly critical to the overall health of HIV patients, as more of them live well into their 70s and 80s.
Michael P. Mullen, MD, directs the Mount Sinai Health System’s six outpatient HIV clinics throughout Manhattan. They treat approximately 10,000 HIV patients, making it one of the largest health programs of its kind in the country, and the largest in New York State, with the most diverse population. According to the New York City Department of Health and Mental Hygiene, the city remains the epicenter of the U.S. HIV epidemic with 72 of every 100,000 New Yorkers infected, versus 23 per 100,000 people nationally.
“Having HIV should be recognized as a risk factor for cardiovascular disease the way it is with diabetes,” says Dr. Myerson. “Today, there are no medical guidelines that tell us how cholesterol should be handled for patients living with HIV. There is a lot more that we have to know.”
HIV patients are believed to be at greater risk for cardiovascular disease for several reasons. The antiretroviral medications they take, particularly protease inhibitors, are believed to adversely affect lipid levels. Patients with HIV also tend to smoke cigarettes at a higher proportion than the general population, and they are now living to an age where heart disease is more prevalent.
Dr. Myerson has set up a program where patients with severe heart failure and coronary artery disease can be closely monitored through frequent doctor and nurse-practitioner visits, so that interventions can take place before patients seek emergency care. Her team has been able to reduce frequent emergency room visits and hospital admissions.
“Mount Sinai is uniquely poised to be a leader in preventing cardiovascular disease in HIV patients,” says Dr. Myerson. This is due to the Health System’s expertise in heart disease treatment and prevention, and its large and diverse HIV patient population, which allows for high-quality research.