HAART, Heart Attacks and Fish Oil

You may have heard HAART (highly active antiretroviral therapy, i.e., HIV medications) increases fat in the blood (triglycerides) and will increase your chances of having a heart attack.

In fact, the chances of having a heart attack from taking HAART is very small. Most people who take HAART do not experience huge increases in fat in their blood. In fact, only about 5-10% do.

While many people think that most protease inhibitors are associated with the most serious increases in triglycerides, there is one protease inhibitor called atazanavir (Reyataz) that does not raise triglyceride levels (or cholesterol levels for that matter) at all. Plus there are many other HIV medications that cause no increase in triglycerides. For example, studies have shown that the NNRTI nevirapine (Viramune) and a few NRTIs cause no increases in blood fat.

A study of over 23,000 people taking HAART has been going on for years. This large study, called the DAD study, looks at the effects of taking antiretroviral therapy on people's health. The DAD study shows there is some increase in the risk of a heart attack from using HAART, but this risk is small.

The DAD study shows several factors increase the risk of a heart attack a lot more than taking antiretroviral drugs. Smoking, for instance, increased the risk of a heart attack a LOT more than HAART -- by 62% in fact.

The most recent analysis of the DAD study shows about an 11% increase in relative risk for every year on HAART. This does not mean you would have an 11% increase in your risk of getting a heart attack. It means if you had a 5% chance of getting a heart attack before getting on HAART, you would have an increase of 11% of the 5%, or .5% after starting HAART. This means your risk, after starting HAART, would go up to 5.5% -- not an increase most people would be concerned about.

The small increased risk of a heart attack is NOT a reason to stop taking HAART. It does mean people who are on HAART who experience elevated triglyceride levels and who are worried about it, could consider taking actions to reduce risks.

If you ARE concerned, keep in mind that quitting smoking reduces your chance of having a heart attack more than HAART increases the risk.

Other studies of heart attacks show that a little exercise helps a lot, especially for people who are at high risk for heart disease. A large study a year ago showed that moderate exercise (walking briskly three times a week) is associated with a 45% lower chance of a heart attack among high risk people.

Finally, you can help lower fat in your blood with diet and medicines. Taking a type of drug called a "statin" reduces risk by lowering triglycerides and cholesterol.

You might also consider eating a lot more fish than you do -- the best for the DHA and EPA that your body needs to lower lipids are: Atlantic Mackerel, Atlantic Salmon, Trout and Arctic Char. EPA and DHA are essential fatty acids which stand for docosahexaenoic acid and eicosahexaenoic acid. You may have heard of them as Omega 3 fats, which are found in cold water fish.

You could also consider taking a gram of fish oil three times a day. Make sure the supplement you use has a lot of DHA and EPA in it. It is clear from several studies that fish oil also reduces blood pressure.

You might want to check out one of the organizations evaluating dietary supplements, like www.consumerlab.com to find a good brand. You can learn more about the benefits of fish oil at: www.pdrhealth.com/drug_info/ nmdrugprofiles/nutsupdrugs/fis_0106.shtml.

The Bottom Line

You don't have to choose between your HIV meds and the health of your heart. Research has confirmed that the increased risk of a heart attack for someone taking HAART is actually quite small.

If you are concerned about the risk of heart attacks the best way to reduce your risk is by not smoking, making sure to exercise, use fish oil and, if necessary, take statins.