Addressing gaps in cardiovascular care for people with HIV: bridging scientific evidence and practice.
Addressing gaps in cardiovascular care for people with HIV: bridging scientific evidence and practice.
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DOI：
10.1097/coh.0000000000000754
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发表时间：
2022-09-01
影响因子：
4.1
通讯作者：
Feinstein, Matthew
中科院分区：
文献类型：
--
作者：
Liu, Albert;Feinstein, Matthew
关键词：
与一般人群相比，艾滋病毒感染者的心血管疾病负担仍然过重。心血管疾病中这些差异的原因包括HIV特异性风险增强剂、传统的动脉粥样硬化性心血管疾病风险因素和社会人口学差异，所有这些都是成熟的干预目标。动脉粥样硬化性心血管疾病的准确风险预测仍然很困难，在缺乏艾滋病毒特异性风险增强剂的情况下，艾滋病毒感染者的心血管风险可能被低估。尽管心血管风险增加，但艾滋病毒感染者治疗不足，经常接受不充分的降脂治疗。结构性种族主义和与艾滋病毒有关的污名化也发挥了作用，因此有必要在提供者一级和结构一级采取干预措施，鼓励及早识别和治疗高危人群。应使用现有的心血管风险预测工具对艾滋病毒感染者进行筛查，并应及时将高危心血管疾病患者转诊，酌情进行生活方式和药物干预。正在进行系统级实施研究，以缩小心血管护理方面的差距，特别是在资源匮乏的弱势社区。
People with HIV continue to have an excess burden of cardiovascular disease compared to the general population. The reasons for these disparities in cardiovascular disease include HIV-specific risk enhancers, traditional atherosclerotic cardiovascular disease risk factors, and sociodemographic disparities, all of which are ripe targets for intervention. Accurate risk prediction of atherosclerotic cardiovascular disease remains difficult, and cardiovascular risk for people with HIV may be underestimated in the absence of HIV-specific risk enhancers. Despite this increased cardiovascular risk, people with HIV are undertreated and often placed on inadequate lipid lowering therapy. Structural racism and HIV-related stigma play a role, and provider-level and structural-level interventions to encourage early identification and treatment of persons at high risk are necessary. Persons with HIV should be screened with existing cardiovascular risk prediction tools, and those at high risk cardiovascular disease should be promptly referred for lifestyle and pharmacologic interventions as appropriate. System-level implementation research is ongoing in attempts to narrow the gap in cardiovascular care, particularly for vulnerable communities in low resource settings.