What a Cardiologist Needs to Know About Patients With Human Immunodeficiency Virus Infection

Hsue, Priscilla Y.; Waters, David D.

doi:10.1161/circulationaha.105.546465

Cited by 48 publications

(45 citation statements)

References 127 publications

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“…21) Clinically, increasing attention has been paid to carotid IMT. Hsue and co-workers have shown that predictors of increased IMT include older age, higher LDL cholesterol, cigarette pack-years, and hypertension in HIV patients, 22) which is broadly consistent with our results in healthy men. Langlois and colleagues reported that increased carotid IMT was associated with high total cholesterol, LDL cholesterol, as well as non-HDL cholesterol and low HDL cholesterol in subjects aged 35 and 55.…”

Section: Discussionsupporting

confidence: 92%

Cholesterol and Triglyceride Concentrations in Lipoproteins as Related to Carotid Intima-Media Thickness

Takahashi¹,

Taguchi²,

Suzuki³

et al. 2012

Int. Heart J.

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SummarySince distinct cholesterol and triglyceride concentrations in major lipoproteins and their subclasses may be related to atherosclerosis, we investigated the relationship of cholesterol and triglyceride concentrations in lipoprotein subclasses and the severity of carotid intima-media thickness (IMT), a surrogate marker of subclinical atherosclerosis. We studied 116 apparently healthy Japanese men (53 ± 9 years) without a history of cardiovascular diseases who were not taking any medication. Carotid IMT was measured by means of high-resolution vascular ultrasound. Plasma cholesterol and triglyceride concentrations in major lipoproteins and their subclasses were determined by HPLC with gel permeation columns. By univariate analyses, carotid IMT was the most closely related to age (r = 0.528, P < 0.001), followed by smoking habit expressed as pack-year cigarette consumption (r = 0.409, P < 0.001). In addition to total cholesterol and LDL cholesterol, carotid IMT was significantly associated with cholesterol and triglyceride concentrations in several LDL and VLDL subclasses. Stepwise multiple linear regression analysis revealed that age (β = 0.436, P < 0.001), smoking (pack-years) (β = 0.225, P = 0.007), and large LDL cholesterol (β = 0.175, P = 0.023) were independent predictors of determining carotid IMT (adjusted R 2 = 0.347, P < 0.001). These results indicate that large LDL cholesterol is an important, independent determinant of carotid IMT in healthy men. (Int Heart J 2012; 53: 29-34) Key words: Intima-media thickness, Lipoprotein, Large low-density lipoprotein cholesterol, High-performance liquid chromatography, Carotid artery T he plasma lipid profile is the most important indicator of risk for cardiovascular disease and stroke. Several components have been proposed as atherogenic lipids and lipoproteins, including low-density lipoprotein (LDL) cholesterol, apolipoprotein B, non-high-density lipoprotein (HDL) cholesterol, triglycerides, and small dense LDL.1,2) Low HDL cholesterol concentrations have gained notice for potentially increasing risk and promoting the development of atherosclerosis. Among plasma lipids, LDL still accounts for the bulk of clinical attention for the prevention of cardiovascular diseases. 3)However, lipoproteins are a heterogeneous group of particles that differ in terms of their physicochemical properties and biological behaviors. Increasingly, attempts have been made to improve evaluation by considering particular subfractions of plasma lipids, in particular LDL and HDL subclasses of atherogenic lipids and lipoproteins. 4) Recently, high-performance liquid chromatography (HPLC) with a gel permeation column has been established as an alternative method for classifying and quantifying lipoproteins on the basis of differences in particle size. 5,6) Intima-media thickness (IMT) in the carotid arteries, measured with high-resolution ultrasonography, is currently the standard clinical marker and a quantitative measure of atherosclerosis; a graded, predictive relationship to over...

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Section: Discussionsupporting

confidence: 92%

Cholesterol and Triglyceride Concentrations in Lipoproteins as Related to Carotid Intima-Media Thickness

Takahashi¹,

Taguchi²,

Suzuki³

et al. 2012

Int. Heart J.

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“…22 Each of these metabolic abnormalities is well documented in HIV-positive patients and may be due to HIV infection or to treatment with drugs such as protease inhibitors as part of highly active antiretroviral therapy (HAART). [23][24][25] In a recent meta-analysis, 15% of HIV-infected patients had osteoporosis, for a pooled odds ratio of 3.7 compared to HIV-negative controls. 26 In a separate study, vitamin D insufficiency (81%) and secondary hyperparathyroidism (26%) were other frequent findings among HIV patients treated with HAART for more than 5 years.…”

Section: Discussionmentioning

confidence: 99%

Calcification of the internal elastic lamina of coronary arteries

et al. 2008

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Two well-recognized patterns of calcification occur in large-and medium-sized arteries, intimal calcification associated with atherosclerosis and medial calcification described by Mö nckeberg. Calcification limited to the internal elastic lamina is a third pattern of calcification not previously reported in coronary arteries. Here we describe 19 cases of coronary artery internal elastic lamina calcification. We serially sectioned and examined the coronary arteries of 66 patients with advanced AIDS and 27 HIVÀ controls with other chronic illnesses. We observed calcification of the internal elastic lamina in 10 HIV þ patients and 9 controls. HIVÀ patients with internal elastic lamina calcification were significantly older than HIVÀ patients without it (P ¼ 0.008) and HIV þ patients with it (P ¼ 0.006). Occasionally, calcification encroached on adjacent intimal or medial tissue with mild fibrosis. There was frequent disruption of the internal elastic lamina but no evidence of inflammation. Calcification was the dominant histologic feature in all cases. Von Kossa, Alizarin red, and trichrome/elastic stains confirmed these findings. Patients with internal elastic lamina calcification often had extensive medical histories but did not suffer from chronic renal failure or other conditions known to cause calcium dysregulation. We describe coronary internal elastic lamina calcification in HIV þ patients and older HIVÀ adults. The clinical significance of this finding is unknown. It could lead to arterial stiffening and increased pulse pressure and could be mistaken for intimal calcification on coronary imaging. Internal elastic lamina calcification may result from premature aging due to HIV disease and chronic illness or from metabolic disorders in HIV þ patients.

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“…17,18 There is thus a persistent inflammatory state in these patients that results in vascular damage and premature atherosclerosis. 19 Some studies have shown a significant increase in non-calcified plaques in HIV patients treated with HAART, which may also be associated with cardiovascular events.…”

Section: Hiv and The Pathophysiology Of Cardiovascular Diseasementioning

confidence: 99%

HIV and coronary disease – When secondary prevention is insufficient

Carvalho

Valente

Morais

et al. 2017

Revista Portuguesa de Cardiologia (English Edition)

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Highly active antiretroviral therapy (HAART) has created a new paradigm for human immunodeficiency virus (HIV)-infected patients, but their increased risk for coronary disease is well documented.We present the case of a 57-year-old man, co-infected with HIV-2 and hepatitis B virus, adequately controlled and with insulin-treated type 2 diabetes and dyslipidemia, who was admitted with non-ST elevation acute myocardial infarction. Coronary angiography performed on day four of hospital stay documented two-vessel disease (mid segment of the right coronary artery [RCA, 90% stenosis] and the first marginal). Tw o drug-eluting stents were successfully implanted. The patient was discharged under dual antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day) and standard coronary artery disease medication. He was admitted to the emergency room four hours after discharge with chest pain radiating to the left arm and inferior ST-segment elevation myocardial infarction was diagnosed. Coronary angiography was performed within one hour and documented thrombosis of both stents. Optical coherence tomography revealed good apposition of the stent in the RCA, with intrastent thrombus. Angioplasty was performed, with a good outcome.The acute stent thrombosis might be explained by the thrombotic potential of HIV infection and diabetes. There are no specific guidelines regarding HAART in secondary prevention of acute coronary syndromes. A multidisciplinary approach is essential for optimal management of these patients. © 2017 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved. Document downloaded from http://www.elsevier.es, day 24/08/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 24/08/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. 569.e2A.S. Carvalho et al. PALAVRAS-CHAVEVírus da imunodeficiência humana; Trombose de stent; Doença coronária VIH e doença coronária ---quando a prevenção secundária é insuficienteResumo A terapêutica antiretroviral (TARV) alterou o paradigma da infeção pelo vírus da imunodeficiência humana (VIH), conhecendo-se o risco aumentado de doença coronária nestes doentes.Apresenta-se o caso de um homem de 57 anos, melanodérmico, com coinfecção VIH-2/vírus hepatite B, com controlo adequado; diabetes mellitus tipo 2, insulino-tratado e dislipidemia. Internado por enfarte agudo do miocárdio, sem supradesnivelamento ST. Realizou cateterismo ao 4.• dia de internamento, documentando-se doença de dois vasos (segmento médio da coronária direita [CD] [90% estenose] e 1. a obtusa marginal [OM1] com estenose de 95%). Colocaram-se dois stents revestidos, sem intercorrências. Teve alta sob dupla antiagregação (ácido acetilsalicílico 100 mg/dia e clopidogrel 75 mg/dia) e restante terapêutica dirigida à doença coronária. Recorreu ao serviço de urgência quatro horas após a alt...

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What a Cardiologist Needs to Know About Patients With Human Immunodeficiency Virus Infection

Cited by 48 publications

References 127 publications

Cholesterol and Triglyceride Concentrations in Lipoproteins as Related to Carotid Intima-Media Thickness

Cholesterol and Triglyceride Concentrations in Lipoproteins as Related to Carotid Intima-Media Thickness

Calcification of the internal elastic lamina of coronary arteries

HIV and coronary disease – When secondary prevention is insufficient

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