Lower adiponectin is associated with subclinical cardiovascular disease among HIV-infected men

Abstract

Objective To examine if altered levels of adipokines, adipose-derived peptides associated with myocardial infarction in the general population, may contribute to subclinical coronary atherosclerosis in HIV-infected persons. Design Nested cohort study. Methods We studied HIV-infected(HIV+) and HIV-uninfected(HIV−) men in the Multicenter AIDS Cohort Study with noncontrast CT to measure coronary artery calcium and regional adiposity; 75% additionally underwent coronary CT angiography to measure plaque composition and stenosis. Adiponectin and leptin levels were assessed. Multiple regression models were used to assess associations between adipokine levels and HIV disease parameters, regional adiposity, and plaque adjusted for age, race, HIV serostatus and CVD risk factors (RFs). Results Significant findings were limited to adiponectin. HIV+ men (n=493) had lower adiponectin levels than HIV− men (n=250) after adjusting for CVD RFs (p<0.0001), which became non-significant after adjustment for abdominal visceral and thigh subcutaneous adipose tissue. Among HIV+ men, lower adiponectin levels were associated with higher CD4+ T cell counts (p= 0.004), longer duration of antiretroviral therapy (p= 0.006) and undetectable HIV RNA levels (p = 0.04) after adjusting for age, race and CVD RFs; only CD4+ cell count remained significant after further adjustment for adipose tissue. In both groups, lower adiponectin levels were associated with increased odds of coronary stenosis > 50% (p <0.007). Lower adiponectin levels were associated with increased extent of plaque in HIV+ and of mixed plaque in HIV− men. Conclusions Adiponectin levels were lower in HIV-infected men and related to the severity of subclinical atherosclerosis, independent of traditional CVD risk factors.

Inflammatory Markers Associated With Subclinical Coronary Artery Disease: The Multicenter AIDS Cohort Study

“…In other words, these markers are not associated with the early stages of atherosclerosis, but are related to a more advanced stage, namely, coronary artery stenosis. These findings are consistent with the results of our previous analyses on the relationship of adiponectin and circulatory markers of monocyte activation with CT scan findings in the MACS population …”

“…These findings are consistent with the results of our previous analyses on the relationship of adiponectin and circulatory markers of monocyte activation with CT scan findings in the MACS population. 44,55 The biomarkers of inflammation and coagulation included in this study are widely used to represent different domains of inflammation (systemic mediators, endothelial cell activation, TNF-a-mediated immune cell activation, and acute phase response proteins) and coagulation, and the generally positive associations suggest widespread involvement of many facets of inflammation in HIV-mediated atherosclerosis. Some of these markers are widely available for clinical use, and have been suggested by other studies to be related to clinical CAD in the general population.…”

Telmisartan to reduce cardiovascular risk in older HIV-infected adults: a pilot study

“…65 Lower adiponectin levels have been associated with increased coronary artery calcification in HIV-infected men. 66 Our data suggest that telmisartan could affect FMD through nitric oxide release and inhibition of vasoconstriction. However, in our population with known CVD risk factors, simultaneous exposure to other drugs with anti-inflammatory properties (aspirin, statins, anti-hypertensive agents) could confound results, and our sample size was too small to fully adjust for concomitant anti-inflammatory medication use.…”

Effect of Recombinant Human Growth Hormone and Rosiglitazone for HIV-Associated Abdominal Fat Accumulation on Adiponectin and other Markers of Inflammation

“…It also appears to correlate with subclinical cardiac disease as assessed by coronary reserve flow in HIV-infected subjects 30 . More recently, a larger study found that HIV-infected men had lower levels of adiponectin compared to HIV-uninfected men, and that these levels were inversely associated with increased coronary stenosis on CT angiography 31 . These observations have led to the hypothesis that adiponectin could serve as a novel predictor of cardiovascular risk as well as a potential target for pharmacologic intervention.…”