Many attempts are being made to identify surrogate markers that may assist in answering the question of risk for cardiac disease in HIV. The most notable are the traditional cardiovascular risk factors including obesity, hypertension, diabetes, smoking, increased LDL cholesterol, and decreased high density lipoprotein (HDL) cholesterol. Other emerging factors evaluating risk include hyperinsulinemia, elevated homocysteine, triglycerides, remnant lipoprotein cholesterol, and lipoprotein (a) (Lp{a}). More specific surrogate markers under investigation include coronary calcification scores and carotid atherosclerosis by ultrafast CT imaging and carotid artery ultrasound to determine intimal thickness. (4) The chronic nature of HIV infection itself may promote atherosclerosis through proinflammatory effects on endothelial cells, a risk factor that may lead to the development of cardiovascular disease in HIV. Other inflammatory markers such as cytokines and C-reactive protein may also play a role in the development of cardiovascular disease. (5)