Predictors of coronary artery calcium incidence and progression: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Cardoso, Rhanderson; Generoso, Giuliano; Staniak, Henrique Lane; Foppa, Murilo; Duncan, Bruce Bartholow; Pereira, Alexandre C.; Blaha, Michael J.; Blankstein, Ron; Nasir, Khurram; Benseñor, Isabela M.; Lotufo, Paulo A; Bittencourt, Márcio

doi:10.1016/j.atherosclerosis.2020.07.003

Cited by 14 publications

(15 citation statements)

References 35 publications

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“…The discrepancy between the HIV effect on overall prevalence of disease (SIS >0) and disease severity (SSS >3) in our study is interesting. Previous literature has demonstrated that different risk factors are associated with initial CAC scores and progression of CAC scores, suggesting different pathophysiology of CAD development and progression [ 21 ]. Whether similar differences exist for PLHIV is unknown.…”

Section: Discussionmentioning

confidence: 99%

Sex modifies the association between HIV and coronary artery disease among older adults in Uganda

et al. 2022

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Introduction Little is known about the epidemiology of coronary artery disease (CAD) in sub‐Saharan Africa, where the majority of people living with HIV (PLHIV) live. We assessed the association of HIV with CAD and explored relationships with monocyte activation in sex‐stratified analyses of older PLHIV and people without HIV (PWOH) in Uganda. Methods The Ugandan Study of HIV effects on the Myocardium and Atherosclerosis (mUTIMA) follows 100 PLHIV on antiretroviral therapy (ART) and 100 age‐ and sex‐matched PWOH controls in Kampala, Uganda; all >45 years of age with >1 cardiovascular disease risk factor. At the year 2 exam (2017–2019), 189 participants had available coronary calcium score and 165 had coronary CT angiography (CCTA) for this analysis. A subset of participants ( n = 107) had both CCTA and fresh whole blood flow cytometry for monocyte phenotyping. Results Median age was 57.8 years and 63% were females. Overall, 88% had hypertension, 37% had diabetes and 4% were smokers. Atherosclerotic cardiovascular disease (ASCVD) risk was modestly higher for PWOH, but not statistically significant (median 10‐year ASCVD risk 7.2% for PLHIV vs. 8.6% for PWOH, p = 0.09). Median duration of ART was 12.7 years and 86% had suppressed viral load. Despite a high prevalence of risk factors, only 34/165 (21%, 95% CI 15–28%) had any coronary plaque. After adjustment for ASCVD risk score, HIV status was not associated with CAD (OR 0.55, 95% CI 0.23–1.30) but was associated with more severe CAD (segment severity score>3) among those with disease (OR 10.9, 95% CI 1.67–70.45). Females had a trend towards higher odds of CAD among PLHIV (OR 4.1, 95% CI 0.4–44.9), but a trend towards lower odds of CAD among PWOH (OR 0.30; 95% CI 0.07–1.3; HIV*sex interaction p = 0.019). CAD was positively correlated with classical monocytes ( r = 0.3, p = 0.012) and negatively correlated with CX3CR1 expression ( r = –0.31, p = 0.011) in PLHIV and negatively correlated with patrolling monocytes ( r = –0.36, p = 0.031) and tissue factor expression ( r = –0.39, p = 0.017) in PWOH. Conclusions Our results suggest that HIV may be associated more with severity rather than the presence of CAD in Uganda. Sex differences in the HIV effect suggest that tailored CAD prevention strategies may be required in this setting.

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Section: Discussionmentioning

confidence: 99%

Sex modifies the association between HIV and coronary artery disease among older adults in Uganda

et al. 2022

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“…Thirteen cohort studies [ 10 , 36 – 46 , 48 ] enrolled 25,442 participants with sample sizes ranging from 21 to 6,011 participants. The duration of follow-up was between 5 and 20 years.…”

Section: Resultsmentioning

confidence: 99%

“…Populations varied in sex distribution and age, and also had mean or median HDL-C levels. Eleven cohorts included both genders [ 10 , 36 – 38 , 40 , 41 , 43 – 46 , 48 ] and two included only women [ 39 , 42 ]. The average age of the participants ranged from 29 to 84 years old.…”

Section: Resultsmentioning

confidence: 99%

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HDL-cholesterol concentration and its association with coronary artery calcification: a systematic review and meta-analysis

et al. 2023

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Background Coronary artery calcification (CAC) is a potential risk marker of coronary atherosclerosis that has high specificity and sensitivity. However, the association between high-density lipoprotein cholesterol (HDL-C) concentration and CAC incidence and progression is controversial. Methods PubMed, Embase, Web of Science, and Scopus were systematically searched to identify relevant observational studies up to March 2023 and assessed the methodological quality using Newcastle-Ottawa Scale (NOS) scale. Random-effects meta-analysis was used to estimate pooled odds ratios (OR) and 95% confidence interval considering heterogeneity across studies. Results Of the 2,411 records, 25 cross-sectional (n = 71,190) and 13 cohort (n = 25,442) studies were included in the systematic review. Ten cross-sectional and eight cohort studies were not eligible and were omitted from the meta-analysis. A total of 15 eligible cross-sectional studies (n = 33,913) were included in the meta-analysis and pooled results revealed no significant association between HDL-C and CAC > 0, CAC > 10, or CAC > 100 [pooled OR: 0.99 (0.97, 1.01)]. Meta-analysis of the 5 eligible prospective cohort studies (n = 10,721) revealed no significant protective effect of high HDL-C against CAC > 0 [pooled OR: 1.02 (0.93, 1.13)]. Conclusions According to this analysis of observational studies, high HDL-C levels were not found to predict protection against CAC. These results suggest HDL quality rather than HDL quantity is important for certain aspects of atherogenesis and CAC. Registration number CRD42021292077.

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“…For example, in the absence of CAC but the presence of risk factors, An alternate use of risk biomarkers is to support selection of patients for CAC measurement. Most risk biomarkers have been shown to associate with the level of CAC (29)(30)(31)(32)(33)(34). In patients with the metabolic syndrome, CAC scores increase progressively with the number of metabolic risk factors (35).…”

Section: Addressing An Aggregation Of Risk Biomarkers Factors In Individuals Is a Different Mattermentioning

confidence: 99%

Prevalence and significance of risk enhancing biomarkers in the United States population at intermediate risk for atherosclerotic disease

Vega

Wang

Grundy

2022

Journal of Clinical Lipidology

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Predictors of coronary artery calcium incidence and progression: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Cited by 14 publications

References 35 publications

Sex modifies the association between HIV and coronary artery disease among older adults in Uganda

Sex modifies the association between HIV and coronary artery disease among older adults in Uganda

HDL-cholesterol concentration and its association with coronary artery calcification: a systematic review and meta-analysis

Prevalence and significance of risk enhancing biomarkers in the United States population at intermediate risk for atherosclerotic disease

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