Coronary artery plaque progression and cardiovascular risk scores in men with and without HIV-infection

Abstract

Objective: The aim of this study was to assess the association of cardiovascular disease (CVD) risk scores and coronary artery plaque (CAP) progression in HIV-infected participants.Methods: We studied men with and without HIV-infection enrolled in the Multicenter AIDS Cohort Study (MACS) CVD study. CAP at baseline and follow-up was assessed with cardiac computed tomography angiography (CCTA). We examined the association between baseline risk scores including pooled cohort equation (PCE), Framingham risk score (FRS), and Data collect of Adverse effects of anti-HIV drugs equation (D:A:D) and CAP progression.Results: We studied 495 men (211 HIV-uninfected, 284 HIV-infected). The adjusted odds ratio (aOR) of total plaque volume (TPV) and noncalcified plaque volume (NCPV) progression in the highest relative to lowest tertile was 9.4 [95% confidence interval (95% CI) 2.4-12.1, P < 0.001)] and 7.7 (95% CI 3.1-19.1, P < 0.001) times greater, respectively, among HIV-uninfected men in the PCE atherosclerotic cardiovascular disease (ASCVD) high vs. low-risk category. Among HIV-infected men, the association for TPV and NCPV progression for the same PCE risk categories, odds ratio (OR) 2.8 (95% CI 1.4-5.8, P < 0.01) and OR 2.4 (95% CI 1.2-4.8, P < 0.05), respectively (P values for interaction by HIV ¼ 0.02 and 0.08, respectively). Similar results were seen for the FRS risk scores. Among HIV-uninfected men, PCE high risk category identified the highest proportion of men with plaque progression in the highest tertile, although in HIV-infected men, high-risk category by D:A:D identified the greatest percentage of men with plaque progression albeit with lower specificity than FRS and PCE.

Polygenic Risk Scores for Prediction of Subclinical Coronary Artery Disease in Persons With Human Immunodeficiency Virus (HIV): The Swiss HIV Cohort Study

“…[3][4][5] Cardiac imaging in PLWH has typically relied on carotid ultrasound for measurement of carotid intima-media thickness (IMT), [6,7] and non-contrast CT for detection of coronary artery calcification (CAC). [8][9][10][11] More recently, in PLWH, we [10,11] and others [12][13][14] have applied coronary CT angiography (CCTA), which can detect not only calcified but also non-calcified plaque including high risk coronary plaque. CCTA is of particular interest in the setting of PLWH, because coronary plaque in younger persons typically is non-calcified [15] and the median age of many Western populations of PLWH is around 50 years.…”

Polygenic Scores and Preclinical Cardiovascular Disease in Individuals With HIV: Insights From the REPRIEVE Trial

“… 5 , 6 Indeed, studies comparing participants with or without HIV infection found that traditional risk models for CAD, such as pooled cohort equations (PCEs) or Framingham Risk Scores, 7 are frequently inaccurate among PWH compared with the general population. 8 , 9 The mechanisms driving the excess risk are poorly understood. Therefore, there is a critical need to develop improved strategies to predict ASCVD in this population, and to identify asymptomatic PWH at greatest risk for future ASCVD to guide preventive measures.…”

“…Coronary computed tomography angiography (CCTA) has emerged as a powerful tool to extract surrogate indices for clinical CAD risk to assess such novel biomarkers. 8 , 20 , 21 …”

Distinct inflammatory profiles linked to cardiovascular disease risk in HIV infection: implications for the design of preventive and therapeutic interventions

“…First, baseline CVD risks are low for cART-naı ¨ve PWH. The Multicenter AIDS Cohort Study (MACS) established that failure of viremic control in those on cART is a key correlate of CVD, as characterized by cardiac plaque progression [8]. But, the large D:A:D (Data Collection on Adverse Events of Anti-HIV Drugs) study found no increase in at least certain types of CVD, including acute myocardial infarction, in the absence of cART [9].…”