Reduced ovarian reserve relates to monocyte activation and subclinical coronary atherosclerotic plaque in women with HIV

Abstract

Objective(s) To investigate differences in subclinical coronary atherosclerotic plaque and markers of immune activation among HIV-infected and non-HIV-infected women categorized by degree of ovarian reserve and menopause status. Design Cross-sectional evaluation. Methods Seventy-four women (49 HIV-infected, 25 non-HIV-infected) without known CVD were classified as premenopausal, premenopausal with reduced ovarian reserve, or postmenopausal based on menstrual history and antimullerian hormone (AMH) levels. Participants underwent contrast enhanced coronary computed tomography angiography (CCTA) and immune phenotyping. Comparisons in coronary atherosclerotic plaque burden and immune markers were made between the HIV-infected and non-HIV-infected women overall and within the HIV-infected and non-HIV-infected women by reproductive classification group. Results Among the overall group of HIV-infected women, the women with reduced ovarian reserve (undetectable AMH) had a higher prevalence of coronary atherosclerotic plaque (52% versus 6%, p=0.0007) and noncalcified plaque (48% versus 6%, p=0.002), as well as higher levels of log sCD163 (p=0.0004) and log MCP-1 (p=0.006), compared with the premenopausal women with measurable AMH. Furthermore, reduced ovarian reserve in the HIV-infected group related to noncalcified plaque, controlling for traditional CVD risk factors (p=0.04) and sCD163 (p=0.03). Conclusions HIV-infected women with reduced ovarian reserve have increased subclinical coronary atherosclerotic plaque compared with premenopausal women in whom AMH is measurable. This relationship holds when controlling for CVD risk factors (including age) and immune activation. Our findings demonstrate that reduced ovarian reserve may contribute to CVD burden in HIV-infected women and support a comprehensive assessment of CVD risk prior to completion of menopause in this population.

Anti-Müllerian Hormone Trajectories Are Associated With Cardiovascular Disease in Women

“…26 A cross-sectional evaluation of both healthy and HIV-infected women concurred that premenopausal women with undetectable AMH levels had larger atherosclerotic plaques than premenopausal women with detectable AMH levels. 27 Although these observations could potentially be explained by a relationship between either ovarian reserve status or AMH levels and lipid measures, 18,[28][29][30] the results of the current study add to evidence suggesting that the association of AMH with CVD occurrence is independent from cholesterol levels. 26,27 It is interesting to note that a previous study did not find any association between age-specific AMH levels and silent coronary artery disease, based on a composite factor of various electrocardiography-based ischemic changes, in a 10-year follow-up period.…”

“…27 Although these observations could potentially be explained by a relationship between either ovarian reserve status or AMH levels and lipid measures, 18,[28][29][30] the results of the current study add to evidence suggesting that the association of AMH with CVD occurrence is independent from cholesterol levels. 26,27 It is interesting to note that a previous study did not find any association between age-specific AMH levels and silent coronary artery disease, based on a composite factor of various electrocardiography-based ischemic changes, in a 10-year follow-up period. 31 The high reported rate of silent coronary artery disease in this population (14%, compared to 4.8% 32 and 3.6/10000 person-years 33 in a Dutch population) suggests that the used classification of silent coronary artery disease may not be entirely able to distinguish the women with clinically relevant coronary-based ischemia from this population.…”

Cardiovascular disease risk among women living with HIV in North America and Europe

“…This findings implies that WLHIV with reduced ovarian reserve who still undergo menstrual cycling should not necessarily be considered to harbor low CVD risk. In this study, among WLHIV, markers of systemic immune activation were also noted to increase across progressive categories of reproductive aging(66). …”

Sex Differences in Select Non-communicable HIV-Associated Comorbidities: Exploring the Role of Systemic Immune Activation/Inflammation

“…Looby et al demonstrated that among WLHIV, reproductive aging is associated with heightened systemic immune activation(79). A series of seminal studies from the WIHS cohort have shown that WLHIV (vs. women without HIV) may experience accelerated reproductive aging.…”