Coronary artery endothelial dysfunction is present in HIV-positive individuals without significant coronary artery disease

Abstract

Objective HIV+ individuals experience an increased burden of coronary artery disease (CAD) not adequately accounted for by traditional CAD risk factors. Coronary endothelial function (CEF), a barometer of vascular health, is depressed early in atherosclerosis and predicts future events but has not been studied in HIV+ individuals. We tested whether CEF is impaired in HIV+ subjects without CAD as compared to an HIV- population matched for cardiac risk factors. Design/Methods In this observational study, CEF was measured noninvasively by quantifying isometric handgrip exercise (IHE)-induced changes in coronary vasoreactivity with MRI in 18 participants with HIV but no CAD (HIV+CAD-, based on prior imaging), 36 age- and cardiac risk factor-matched healthy participants with neither HIV nor CAD (HIV-CAD-), 41 subjects with no HIV but with known CAD (HIV-CAD+) and 17 subjects with both HIV and CAD (HIV+CAD+). Results CEF was significantly depressed in HIV+CAD- subjects as compared to that of risk-factor-matched HIV-CAD- subjects (p<0.0001), and was depressed to the level of that in HIV- participants with established CAD. Mean IL-6 levels were higher in HIV+ participants (p<0.0001), and inversely related to CEF in the HIV+ subjects (p=0.007). Conclusions Marked coronary endothelial dysfunction is present in HIV+ subjects without significant CAD and is as severe as that in clinical CAD patients. Furthermore, endothelial dysfunction appears inversely related to the degree of inflammation in HIV+ subjects, as measured by IL-6. CEF testing in HIV+ patients may be useful for assessing cardiovascular risk and testing new CAD treatment strategies, including those targeting inflammation.

Cardiac Microvascular Dysfunction in Women Living With HIV Is Associated With Cytomegalovirus Immunoglobulin G

“…Two previous studies found that MLWH with low CVD risk have MFRs comparable to HIV-uninfected men [ 16 , 30 ]. On the other hand, a recent study of PLWH both with and without CAD found that PLWH (63% men) without CAD had coronary endothelial function, as assessed by coronary MRI, comparable to HIV-uninfected patients with CAD, with no obvious influence of sex [ 31 ]. These studies used different imaging modalities, including cardiac stress testing protocols, which arguably could lead to different results.…”

Non-invasive assessment of coronary endothelial function in children and adolescents with type 1 diabetes mellitus using isometric handgrip exercise—MRI: A feasibility study

“…Indeed, in vivo studies demonstrate the vasomotor response to IHE is primarily mediated by nitric oxide [20] and therefore, reflects endothelial function [6,[21][22][23][24][25]. The feasibility of the IHE-MRI technique to assess vasomotor reactivity in coronary arteries has been studied in patients with coronary artery disease as well as patients with HIV [18,21,26]. Phantom study results suggest that radial MRI is capable of distinguishing area differences in the order of 0.2-0.3 mm 2 (i.e.…”

Atrial fibrillation and human immunodeficiency virus type‐1 infection: a systematic review. Implications for anticoagulant and antiarrhythmic therapy

“…Beside drugs, several pathophysiological alterations potentially contributing to the increased CVD risk have been reported in association with HIV‐1 infection. For instance, HIV‐1 infected patients are characterized by increased oxidative stress , endothelial/vascular dysfunction and platelet activation , again all factors potentially contributing to the atherosclerotic burden in HIV‐1 patients .…”