Comparison of Racial Differences in Plaque Composition and Stenosis Between HIV-Positive and HIV-Negative Men from the Multicenter AIDS Cohort Study

Abstract

Previous studies demonstrated that blacks have less coronary artery calcification (CAC) than whites. We evaluated racial differences in plaque composition and stenosis in the Multicenter AIDS Cohort Study (MACS). HIV positive and negative men completed non-contrast cardiac CT if they were 40–70 years, weighed <300 pounds, and had no prior history of cardiac surgery or revascularization, and if eligible, coronary CT angiography (CTA). There were 1001 men who underwent CT scans and 759 men had CTA. We measured CAC on non-contrast CT, and total plaque, non-calcified, calcified, and mixed plaque, and identified coronary stenosis >50% on CTA. The association of presence and extent of plaque with race was determined after adjustment for HIV serostatus, cardiovascular risk factors and measures of socioeconomic status. The prevalences of any plaque on CTA and non-calcified plaque were not different between black and white men; however, black men had lower prevalences of CAC (Prevalence ratio (PR)=0.79, p=0.01), calcified plaque (PR=0.69, p=0.002), and stenosis >50% (PR=0.59, p=0.009). There were no associations between black race and extent of plaque in fully adjusted models. Using log-linear regression, black race was associated with a lower extent of any plaque on CTA in HIV positive men (estimate=−0.24, p=0.051) but not in HIV negative men (0.12, p=0.50, HIV interaction p=0.005). In conclusion, a lower prevalence of CAC in black compared to white men appears to reflect less calcification of plaque and stenosis rather than a lower overall prevalence of plaque.

HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS)

“…In contrast, black men and men with higher levels of HDL-C were less likely to have positive remodeling. We previously demonstrated a lower prevalence of CAC, calcified plaque, and stenosis greater than 50% among black participants compared to white participants [26]. Among HIV-specific factors, PR was positively associated with a history of AIDS and inversely associated with nadir CD4+ T cell count, although there were no associations with years on HAART or protease inhibitors.…”

Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association

“…155 However, an unexpected observation that warrants further investigation is that, when the subclinical coronary artery disease burden was compared between African American men with and without HIV in MACS (Multicenter AIDS Cohort Study), HIV positivity was associated with lower volume of total plaque. 156 Pharmacotherapy to manage HIV may increase the risks of CVDs. Although race-specific data were not presented, HIV-positive adults tend to have more dyslipidemia, characterized as high triglycerides and low HDL cholesterol (HDL-C) levels, likely as a result of decreased cholesterol ester transfer protein activity 157 compared with HIV-negative individuals.…”