Clinical Infectious Diseases, January 2020
Memory problems, difficulty concentrating, and inability to multi-task, among other cognitive issues, are common complaints of people living and aging with HIV. Although our understanding of the causes of cognitive dysfunction in people living with HIV is limited, there are a number of conditions that have been shown to increase the risk of cognitive impairment. Cardiovascular risk factors, including a history of heart disease, diabetes mellitus, and high cholesterol, seem to play an important role in the development of cognitive issues in people living with HIV, similar to what is observed in the general population. Therefore, this study, which was embedded in the A5322 study (Long-Term Follow-up of Older HIV-infected Adults in the ACTG: Addressing Issues of Aging, HIV Infection and Inflammation (HAILO)), sought to investigate whether having a combination of several cardiovascular risk factors might help predict impairments in cognitive function in the future.
The authors calculated a cardiovascular risk score for participants at the time they entered A5322 using the following data: age, sex, race/ethnicity, systolic blood pressure, total cholesterol, HDL cholesterol (the “good” cholesterol), use of blood pressure medications, current smoking, and a history of diabetes mellitus. Cognition was assessed every year in A5322 using a series of pen and paper tests that measure memory, speed of information processing, attention, and executive function.
Among the 988 participants included in this study, all of whom were 40 years of age and older, we found that a higher cardiovascular risk score at the first A5322 study visit could predict poorer cognitive function four years later at a follow-up visit. Because studies have shown that the risk factors for cognitive impairment in women may be different than in men, the authors also analyzed participants separately by sex. When the group was split into women and men, we observed that the harmful effect of a higher cardiovascular risk score on future cognitive function was much more pronounced in women than in men.
These results suggest that cardiovascular risk factors are an important contributor to cognitive issues in all people living with HIV, but particularly in women. Estimating someone’s cardiovascular risk using a simple cardiovascular risk score (e.g., the Atherosclerotic Cardiovascular Disease risk score) may help to identify people, especially women, who are at risk for worse cognition over time. We need to learn more about whether lowering cardiovascular risk (e.g., taking blood pressure medications, staying physically active, quitting smoking) can actually reduce the risk of cognitive impairment and slow cognitive decline in people living with HIV. Given the differences in how cardiovascular risk may affect the cognition of women and men living with HIV, it is especially important for women living with HIV to be included in future studies investigating ways to lower cardiovascular risk and improve brain health.
Chow, F. C., Lyass, A., Mahoney, T. F., Massaro, J. M., Triant, V. A., Wu, K., Berzins, B., Robertson, K., Ellis, R. J., Tassiopoulos, K., Taiwo, B., D’Agostino, R. B., Sr, & ACTG A5322 Study Team (2020). Baseline 10-year cardiovascular risk scores predict cognitive function in older persons, and particularly women, living with HIV infection. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, ciz1214. Advance online publication. https://doi.org/10.1093/cid/ciz1214