Modest increase in rate of cardiovascular disease progression during perimenopause for women living with HIV

Declining oestrogen levels during menopause are associated with increased cardiovascular risk. A longitudinal cohort study evaluated early markers of atherosclerosis (e.g. carotid artery stiffness) at two to three year intervals.

Increased arterial thickening was observed for perimenopausal women living with HIV compared to premenopause (difference in slope: 1.64 µm/year, p = 0.002).

Use of hormone replacement therapy (HRT) may reduce cardiovascular risk for menopausal women living with HIV.

This longitudinal cohort study between 2004 and 2019 included regular monitoring of carotid artery stiffness and plaque development. Participants (n=979) were Black (62%), Hispanic (28%) or white (7%), median age at enrolment was 40 years (IQR: 34 to 46) and median BMI was 28.3 kg/m²(IQR: 24.3 to 33.6). Women living with HIV (n=703) were receiving ART (69%) and median baseline viral load and CD4 counts were 210 copies/mL (IQR: 80 to 8450) and 445 cells/mm³ (IQR: 281 to 661), respectively.

Progression of carotid artery thickening was greatest for perimenopausal women living with HIV. Across the study, the rate of arterial stiffening was not dependent on HIV status.

Increased arterial thickness may lead to greater risk of cardiovascular disease for women living with HIV. Use of HRT may be beneficial for menopausal women living with HIV.

comment

Some of the limitations of this study include the imbalance of women with and without HIV, the lack of effect on plaque progression, low level of ART use and related high viral load.

Additionally, menopause data was self-reported for the final menstrual period.