HIV and coronary artery calcium score: comparison of the Hawaii Aging with HIV Cardiovascular Study and Multi-Ethnic Study of Atherosclerosis (MESA) cohorts

Abstract

Objectives To determine the association of HIV, immunologic, and inflammatory factors on coronary artery calcium (CAC), a marker of subclinical atherosclerosis. Methods Cross-sectional study comparing baseline data of males from Hawaii Aging with HIV –Cardiovascular Study (HAHCS) with the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. The cohorts were pooled to determine effects of HIV on CAC and explore immunologic and inflammatory factors that may explain development of CAC in HIV. Multivariable regression models compared CAC prevalence in HAHCS with MESA adjusting for coronary heart disease (CHD) risk profiles. Results We studied 100 men from HAHCS and 2733 men from MESA. Positive CAC was seen in 58% HAHCS participants and 57% MESA participants. Mean CAC was 260.8 in HAHCS and 306.5 in MESA. Using relative risk (RR) regression, HAHCS participants had a greater risk (RR=1.20, P<0.05) of having positive CAC than MESA when adjusting for age, smoking status, diabetes, antihypertensive therapy, BMI, systolic blood pressure, total cholesterol, and HDL cholesterol. Among participants with positive CAC, HIV infection was not associated with larger amounts of CAC. Among HAHCS participants, current HIV viral load, CD4, length of HIV, interleukin 6 (IL-6), fibrinogen, C-reactive protein (CRP), and D-dimer were not associated with the presence or amount of CAC. Discussion HIV was independently associated with a positive CAC in men with increased likelihood occurring between 45 and 50 years of age. Current HIV viral load, CD4 count, length of HIV, and inflammatory markers were unrelated to either presence or amount of CAC.

Cardiovascular disease risk scores’ relationship to subclinical cardiovascular disease among HIV-infected and HIV-uninfected men

“…Currently, there is limited data on the associations between cardiovascular disease risk score and subclinical atherosclerosis (including CAC) among individuals with HIV. One study reported a higher FRS among HIV-infected individuals with versus without CAC (mean FRS of 0.19 and 0.12, respectively) [15]. …”

Subclinical atherosclerosis and endothelial dysfunction in patients with HIV infection: is there any new diagnostic test?

“…In other study of similar methodologic characteristics, no association was observed between lymphocyte subpopulations and VL with coronary calcium score in patients with HIV infection. This fact is probably related to greater prevalence of classic vascular risk factors in the included population, since the patients were older and a large percentage of them were smokers (63%) [11]. However, in other studies with a lower percentage of smokers, whom people included is more similar to our population, the progression over time of coronary calcium score was related to the viral load of the patients the coronary and to the number of CD4 cells [12][13].…”

“…New analytical and radiological markers are being investigated in order to achieve an earlier diagnosis of atherosclerosis that will allow a more accurate selection of patients who need to perform a primary cardiovascular prophylaxis [6]. Among radiological tests to determinate subclinical atherosclerosis, carotid doppler ultrasound [7][8][9][10] for the measurement of mean intimate thickness (IMT) and coronary artery calcium score [11][12][13] are are the most studied ones in HIV-infected people.…”

An Exploration the Risk of Cardiovascular Disease in HIV-Positive Persons in Indonesia using Heart Rate Variability

“…In the era before ART (pre-ART) was found only 5% of deaths caused by heart disease, but now, in the era posts-ART, 32-42% of HIV patients die due to heart disease (Krentz, Kliewer, & Gill, 2015;Palella et al, 2016). Patients with HIV have 1.5 to 2 times the cardiovascular risk compared to people who are not infected with HIV and that increases with age (Chow et al, 2015;Triant, Lee, Hadigan, & Grinspoon, 2007). Another study reported that about 58.3% of patients with HIV had at least one cardiovascular risk factor and 18.9% had two and more cardiovascular risk factors (Soliman et al, 2015).…”