Association of epicardial fat with noncalcified coronary plaque volume and with low attenuation plaque in people with HIV

Abstract

a,b,d , for the investigators of the Canadian HIV and Aging Cohort Study Objectives: People with HIV are exposed to a higher risk of coronary artery disease (CAD) compared with the general population. Epicardial fat may play a unique role in promoting coronary atherosclerosis. We measured epicardial fat in participants living with HIV and controls and investigated its association with coronary plaque volume and low attenuation plaque, a marker of plaque vulnerability.Design: This is a cross-sectional study, nested in the Canadian HIV and Aging Cohort Study, a large prospective cohort actively following participants with HIV and controls. Participants with low/intermediate cardiovascular risk without symptoms/history of CAD were invited to undergo cardiac computed tomography (CT).Methods: Volume of epicardial fat, coronary plaque and low attenuation component of the plaque were measured. Association between epicardial fat, coronary plaque volume and low attenuation component was tested using adjusted regression analysis.Results: A total of 169 participants with HIV and 81 controls underwent cardiac CT. Participants with HIV had a greater epicardial fat volume compared with controls (P ¼ 0.019). In participants with HIV, epicardial fat volume was positively associated with duration of nonnucleoside reverse transcriptase inhibitors (NNRTI) (b¼2.19, P ¼ 0.004). After adjustment for cardiovascular risk factors, epicardial fat volume was positively associated to noncalcified plaque volume [odds ratio (OR) ¼ 1.09, P ¼ 0.028] and to the low-attenuation plaque component portion (b¼0.38, P ¼ 0.026). Conclusion:The association of epicardial fat volume to noncalcified plaque volume and to low attenuation component plaque may suggest a potential mechanism by which epicardial fat could be a silent driver of CAD in the HIV population.

Higher epicardial fat in older adults living with HIV with viral suppression and relationship with liver steatosis, coronary calcium and cardiometabolic risks

“…Our study results also confirm the previous evidence that EAT volume was affected by HIV infection, and it is associated with duration of HIV [20,22,30]. This confirms the previous study suggesting that PWH had distinct features from HIV-negative individuals in addition to the traditional cardiometabolic risk factors, which are associated with the formation of ectopic fat deposition through multiple mechanisms including persistent inflammation and immune activation [29]. Despite the lack of evidence for the association of ART, such as D4T and ABC in our PWH model, other studies have described that certain ART drugs were associated with increased pericardial fat volume [22].…”

“…Coronary calcification remained a significant predictor for EAT volume after adjusting for demographics, HIV status and other cardiometabolic risk factors in our study. Previous reports have also demonstrated the association of epicardial fat and high-risk coronary plaque [14,15,29], possibly resulted from the inflammatory reactions in the local tissues of the arteries. However, we were not able to identify an association of high-risk plaques with EAT volume because of a lack of data on volumetric analysis and information on plaque sub-types.…”

Epicardial fat density, coronary artery disease and inflammation in people living with HIV

“…[16,38,39] We and others have demonstrated that a longer exposure to ART and to some specific ART classes were associated with an increased EF volume. [10,11]…”

“…Participant's characteristics stratified by HIV status are listed in Table 1. PLHIV had a similar 10-year Framingham risk score (median of 10% [7][8][9][10][11][12][13][14][15][16] for PLHIV and 9% [7][8][9][10][11][12][13][14][15] for controls, P = .414). PLHIV were more likely to be male (92.0% for PLHIV vs 77.1% for controls, P = .002), to smoke more (median smoking exposure of 6 [0-24.4] pack/years for PLHIV vs 0 [0-8.4] for controls, P = .001) and had a lower cholesterol level (mean total cholesterol of 4.9 ± 1.1 for PLHIV vs 5.3 ± 1.0 for controls, P = .003).…”

“…[8,9] Several studies have shown that the amount of EF is increased in participants living with HIV (PLHIV), and that it is associated with a greater risk of CAD. [10][11][12] On the other hand, only a limited number of studies have explored how EF quality, beyond its quantity, can be related to inflammation and cardiovascular health among PLHIV. [13][14][15] Fat quality can be measured using fat computed tomography (CT) density (or CT attenuation, in Hounsfield units [HU]).…”