Epicardial Adipose Tissue Volume and Cardiovascular Risk Indices among Asymptomatic Women with and without HIV

Srinivasa, Suman; Lu, Michael T.; Fitch, Kathleen V.; Hallett, Travis R.; O’Malley, Timothy K; Stone, Lauren; Martin, Amanda; Coromilas, Alexandra; Burdo, Tricia H.; Triant, Virginia A.; Lo, Janet; Looby, Sara E; Neilan, Tomas G.; Zanni, Markella V.

doi:10.3851/imp3193

Cited by 11 publications

(12 citation statements)

References 22 publications

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“…In our study, we found a positive association between epicardial fat volume and exposure to ART, and more specifically to NNRTIs. Although there have been reports of increased epicardial fat with exposure to NRTIs [25,34,40], and protease inhibitors [41], this finding related to NNRTIs is novel. It should be noted, however, that combinations of ARTs were used in our participants, and therefore, we cannot exclude that the increase of epicardial fat associated to NNRTI may result from a combination effect of NNRTI with other classes, in particular the NRTIs.…”

Section: Discussionmentioning

confidence: 95%

“…It has been previously shown that epicardial fat in individuals living with HIV correlates to coronary calcium score [40], plaque prevalence [25] and to an increased risk of adverse cardiovascular events [23]. Using CCTA, Brener et al [25] and Srinivasa et al [34] showed that epicardial fat volume is associated to noncalcified coronary plaques in HIV patients. Our study adds to the current knowledge by demonstrating an independent relationship between epicardial fat volume and noncalcified plaque volume.…”

Section: Discussionmentioning

confidence: 99%

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Association of epicardial fat with noncalcified coronary plaque volume and with low attenuation plaque in people with HIV

Sadouni

Durand

Boldeanu³

et al. 2021

Aids

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a,b,d , for the investigators of the Canadian HIV and Aging Cohort Study Objectives: People with HIV are exposed to a higher risk of coronary artery disease (CAD) compared with the general population. Epicardial fat may play a unique role in promoting coronary atherosclerosis. We measured epicardial fat in participants living with HIV and controls and investigated its association with coronary plaque volume and low attenuation plaque, a marker of plaque vulnerability.Design: This is a cross-sectional study, nested in the Canadian HIV and Aging Cohort Study, a large prospective cohort actively following participants with HIV and controls. Participants with low/intermediate cardiovascular risk without symptoms/history of CAD were invited to undergo cardiac computed tomography (CT).Methods: Volume of epicardial fat, coronary plaque and low attenuation component of the plaque were measured. Association between epicardial fat, coronary plaque volume and low attenuation component was tested using adjusted regression analysis.Results: A total of 169 participants with HIV and 81 controls underwent cardiac CT. Participants with HIV had a greater epicardial fat volume compared with controls (P ¼ 0.019). In participants with HIV, epicardial fat volume was positively associated with duration of nonnucleoside reverse transcriptase inhibitors (NNRTI) (b¼2.19, P ¼ 0.004). After adjustment for cardiovascular risk factors, epicardial fat volume was positively associated to noncalcified plaque volume [odds ratio (OR) ¼ 1.09, P ¼ 0.028] and to the low-attenuation plaque component portion (b¼0.38, P ¼ 0.026). Conclusion:The association of epicardial fat volume to noncalcified plaque volume and to low attenuation component plaque may suggest a potential mechanism by which epicardial fat could be a silent driver of CAD in the HIV population.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Association of epicardial fat with noncalcified coronary plaque volume and with low attenuation plaque in people with HIV

Sadouni

Durand

Boldeanu³

et al. 2021

Aids

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“…These inconsistencies may be attributed to differences in sex, duration of the infection and ART therapy, as well as CV risk profile. Thus, women with and without HIV had similar volumes of EAT in a study conducted by Srinivasa et al [33], underlining gender‐specific differences in ectopic fat deposition in HIV. However, when groups were stratified by HIV serostatus and high/low EAT, highest levels of immune activation/arterial inflammation markers were observed among HIV‐infected women with excess EAT.…”

Section: Epicardial/pericardial Adipose Tissue (Table 2)mentioning

confidence: 53%

“…Finally, a significant relationship between EAT/PAT volume/density and insulin resistance, as well as a linear relation of EAT/PAT volume with VAT and mixed form lipodystrophy phenotypes have been demonstrated in both HIV men and women in several studies [27,30‐33,36,45,46].…”

Section: Epicardial/pericardial Adipose Tissue (Table 2)mentioning

confidence: 99%

Cardiac adiposity as a modulator of cardiovascular disease in HIV

et al. 2021

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Background With the number of people living with human immunodeficiency virus (HIV) steadily increasing, cardiovascular disease has emerged as a leading cause of non‐HIV related mortality. People living with HIV (PLWH) appear to be at increased risk of coronary artery disease and heart failure (HF), while the underlying mechanism appears to be multifactorial. In the general population, ectopic cardiac adiposity has been highlighted as an important modulator of accelerated coronary artery atherosclerosis, arrhythmogenesis and HF with preserved ejection fraction (HFpEF). Cardiac adiposity is also strongly linked with obesity, especially with visceral adipose tissue accumulation. Aims This review aims to summarize the possible role of cardiac fat depositions, assessed by imaging modalities,as potential contributors to the increased cardiac morbidity and mortality seen in PLWH, as well as therapeutic targets in the current ART era. Materials & Methods Review of contemporary literature on this topic. Discussion Despite antiretroviral therapy (ART), PLWH have evidence of persistent, HIV‐related systemic inflammation and body fat alterations. Cardiac adiposity can play an additional role in the pathogenesis of cardiovascular disease in the HIV setting. Imaging modalities such as echocardiography, cardiac multidetector computed tomography and cardiac magnetic resonance have demonstrated increased adipose tissue. Studies show that high cardiac fat depots play an additive role in promoting coronary artery atherosclerosis and HFpEF in PLWH. Systemic inflammation due to HIV infection, metabolic adverse effects of ART, adipose alterations in the ageing HIV population, inflammation and immune activation are likely important mechanisms for adipose dysfunction and disproportionately occurrence of ectopic fat depots in the heart among PLWH. Conclusions High cardiac adiposity seems to plays an additive role in promoting coronary artery atherosclerosis and HFpEF in PLWH. The underlying mechanisms are multiple and warrant further investigation. Improved understanding of the regulating mechanisms that increase cardiovascular risk in HIV infection may give rise to more tailored therapeutic strategies targeting cardiac fat depots.

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“…The effect of EAT in PLWHIV may differ between sex. Srinivasa et al assessed 55 HIV-positive and 27 HIV-negative women for the impact on EAT on CVD (81). Whilst both groups exhibited a similar EAT volume in the HIV-negative group the EAT volume was significantly associated with CVD risk scores (p=0.02).…”

Section: Beyond Its Regulation Of Myocardial Energy Eat Has Several Other Cardioprotective Functionsmentioning

confidence: 99%

Cardiovascular computed tomography and HIV: The evolving role of imaging biomarkers in enhanced risk prediction

Heseltine

Murray

Khoo

et al. 2021

Imaging

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The treatment of human immunodeficiency virus (HIV) with antiretroviral (ARV) medications has revolutionised the care for these patients. The dramatic increase in life expectancy has brought new challenges in treating diseases of aging in this cohort. Cardiovascular disease (CVD) is now a leading cause of morbidity and mortality with risk matched HIV-positive patients having double the risk of MI compared to HIV-negative patients. This enhanced risk is secondary to the interplay the virus (and accessory proteins), ARV medications and traditional risk factors. The culmination of these factors can lead to a hybrid metabolic syndrome characterised by heightened ectopic fat . Cardiovascular computed tomography (CT) is ideal for quantifying epicardial adipose tissue volumes, hepatosteatosis and cardiovascular disease burden. The CVD risk attributed to disease burden and plaque morphology is well established in general populations but is less clear in HIV populations. The purpose of this review article is to appraise the latest data on CVD development in HIV-positive patients and how the use of cardiovascular CT may be used to enhance risk prediction in this population. This may have important implications on individualised treatment decisions and risk reduction strategies which will improve the care of these patients.

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Epicardial Adipose Tissue Volume and Cardiovascular Risk Indices among Asymptomatic Women with and without HIV

Cited by 11 publications

References 22 publications

Association of epicardial fat with noncalcified coronary plaque volume and with low attenuation plaque in people with HIV

Association of epicardial fat with noncalcified coronary plaque volume and with low attenuation plaque in people with HIV

Cardiac adiposity as a modulator of cardiovascular disease in HIV

Cardiovascular computed tomography and HIV: The evolving role of imaging biomarkers in enhanced risk prediction

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