More than half of people with HIV have an excess heart age of at least ten years

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People living with HIV in the United States have a higher risk of cardiovascular disease as expressed by their ‘heart age’, Dr Angela Thompson-Paul and colleagues report in the October issue of AIDS. Using data from the HIV Outpatient Study, an ongoing, prospective cohort study, individual cardiovascular risk factor profiles were used to estimate heart age in people receiving care in HIV clinics in the US.

Heart age is a way to understand a person’s risk of heart disease. The difference between a person’s heart age and their real age makes it easier to understand and interpret a person’s cardiovascular risk. A younger heart age means a lower risk of heart disease.

However, the researchers estimated heart age in the same way as would be done for the general population, which may in fact underestimate excess heart age in people with HIV.



Relating to the heart and blood vessels.


A waxy substance, mostly made by the body and used to produce steroid hormones. High levels can be associated with atherosclerosis. There are two main types of cholesterol: low-density lipoprotein (LDL) or ‘bad’ cholesterol (which may put people at risk for heart disease and other serious conditions), and high-density lipoprotein (HDL) or ‘good’ cholesterol (which helps get rid of LDL).

body mass index (BMI)

Body mass index, or BMI, is a measure of body size. It combines a person's weight with their height. The BMI gives an idea of whether a person has the correct weight for their height. Below 18.5 is considered underweight; between 18.5 and 25 is normal; between 25 and 30 is overweight; and over 30 is obese. Many BMI calculators can be found on the internet.

prospective study

A type of longitudinal study in which people join the study and information is then collected on them for several weeks, months or years. 


A group of diseases characterized by high levels of blood sugar (glucose). Type 1 diabetes occurs when the body fails to produce insulin, which is a hormone that regulates blood sugar. Type 2 diabetes occurs when the body either does not produce enough insulin or does not use insulin normally (insulin resistance). Common symptoms of diabetes include frequent urination, unusual thirst and extreme hunger. Some antiretroviral drugs may increase the risk of type 2 diabetes.

Two models were used to calculate heart age, based on sociodemographic and clinical characteristics. The first model included cholesterol levels, blood pressure, taking medication for high blood pressure, diabetes, smoking and age. The second model does not require laboratory data, using body mass index (BMI) in place of cholesterol.

Data from 3086 participants (2467 men and 619 women) aged 30 to 74, without prior cardiovascular disease (CVD), seen between 2010 and 2017 were used. Of the men 53% were white and 54% had more than a high school education. Of the women, 55% were black and 56% had a high school education or less.

The average age for men was 49 years, but their heart age was 61 years – which means that the average excess heart age among men was 12 years. Women had a similar average age to men; however, their heart age was 62 years, which means that they had an excess heart age of 13 years.

Excess heart age was greatest among people aged 50 to 59 years (men: 14 years, women: 16 years) and those who were on statins (men: 15 years, women: 19 years).  Excess heart age was also high in people taking aspirin, who have hepatitis C, or had less than a high school education.

Heart age exceeded chronological age by at least 10 years among 53% of men and 59% of women studied.

Excess heart age was higher among women than men across key sociodemographic and clinical characteristics. Compared with men, women had higher prevalence of certain CVD risk factors, more advanced HIV disease, and a lower prevalence of HIV viral suppression.

Both models provided similar estimates of heart age, which suggests that either could be used.

The excess heart age estimates in this study are higher than those of the general population in the United States – 8 years for men and 5 years for women.

“Among people living with HIV, CVD risk factors should be addressed early and proactively,” the investigators conclude. “Routine use of the heart age calculator may help optimize CVD risk stratification and facilitate interventions for aging people living with HIV”.


Thompson-Paul A et al. Excess heart age in adult outpatients in routine HIV care. AIDS 33: 1935-1942, 2019. 

doi: 10.1097/QAD.0000000000002304