Treatment of people with HIV with combination antiretroviral therapy (ART, a mix or "cocktail" of drugs that fight the virus which causes HIV) has greatly improved the health and life span of people living with HIV infections.

Yet these drugs significantly raise the risk of heart attacks. In one evaluation of 23,000 HIV patients treated with combination ART, the incidence of heart attacks rose by 26 percent each year. This means, of course, that the longer a patient takes this form of therapy, the greater his or her risk of a heart attack. Although this risk was greater in older people and in men, younger individuals taking combination ART were also susceptible to heart attacks.

The increased number of heart attacks has been attributed to the impact of ART drugs on metabolic risk factors for coronary heart disease. They can lead to insulin resistance and diabetes, and they often raise blood levels of lipids, especially triglycerides.

The absolute risk of heart attacks, even with ART, is low and must be balanced against the extraordinary benefits of these drugs in prolonging life and health for people with HIV.

Interestingly, if not surprisingly, the smokers in this study had more heart attacks. People who take antiretroviral drugs should recognize they may reduce their heart attack risk if they stop smoking and follow aggressive measures to lower their high cholesterol and triglyceride levels.