Untreated HIV Infection and Large and Small Artery Elasticity

Abstract

Background Untreated HIV infection may increase risk for cardiovascular disease, and arterial elasticity is a marker of cardiovascular risk and early disease. Methods HIV-infected participants not taking antiretroviral therapy (n = 32) were compared with HIV-negative controls (n = 30). Large and small artery elasticity (LAE and SAE) were estimated via analysis of radial pulse waveforms. Differences in LAE and SAE by HIV status were compared using analysis of covariance, with and without adjustment for Framingham risk (model 1); covariates that differed between groups [smoking, injection drug use, hepatitis C, and high-density lipoprotein cholesterol (HDLc); model 2]; or age, sex, race/ethnicity, smoking, injection drug use, hepatitis C, HDLc, and non-HDLc (model 3). Results HIV infection was associated with impaired LAE (−2.55 mL/mm Hg × 10; P = 0.02) and SAE (−1.50 mL/mm Hg × 100; P = 0.02). Associations with traditional risk factors were often stronger for SAE than LAE, including with Framingham score (per 1% higher; SAE −0.18, P = 0.01; LAE −0.19, P = 0.13). Fasting lipid levels were not significantly associated with LAE and SAE. After adjustment, differences between HIV-infected and HIV-uninfected participants were similar in model 1 (−2.36 for LAE, P = 0.04; −1.31 for SAE, P = 0.04), model 2 (−2.67 for LAE, P = 0.02; −1.13 for SAE, P = 0.07) and model 3 (−2.91 for LAE, P = 0.02; −1.34 for SAE, P = 0.03). CD4 count and HIV RNA level were not associated with LAE and SAE among HIV-infected participants. Conclusions Untreated HIV infection is associated with impaired arterial elasticity, of both the large and small vasculature, after controlling for additional risk factors. Pulse waveform analysis is a noninvasive technique to assess cardiovascular disease risk that should be evaluated in larger studies of HIV-infected persons.

Prehypertension, Hypertension, and the Risk of Acute Myocardial Infarction in HIV-Infected and -Uninfected Veterans

“…This finding, however, should be interpreted carefully because we may have been underpowered to detect a significant interaction. Moreover, there are prior studies reporting significant associations between HIV and renal disease [27], endothelial dysfunction [28], reduced arterial elasticity [29], and progression of atherosclerosis [30][31][32], which in turn are associated with elevated blood pressure and cardiac events.…”

Association between Arterial Elasticity Indices and Coronary Artery Calcium in a Healthy Multi-Ethnic Cohort

“…Both LAE and SAE have been shown to correlate with cardiovascular risk factors and the Framingham risk score [2,3,12], while SAE predicted CVD in a recent study [14]. Notably, a prospective study of coronary artery disease patients being treated with conventional therapies demonstrated a more favorable prognosis in the subgroup with improvement in arterial elasticity indices [44].…”

“…Arterial elasticity has been closely associated with traditional cardiovascular risk factors [2,3] as well as cardiovascular mortality [4,5]. In this context, aortic pulse wave velocity has been shown to be a valuable predictor of cardiovascular outcomes in patients with diabetes [6], hypertension [7], and kidney disease [8] as well as the general community [9], though most of these studies included higher-risk patient populations.…”

Is Vascular Stiffness a Target for Therapy?

“…Untreated HIV infection is associated with decreased large and small arterial elasticity even after controlling for cardiovascular risk factors [40]. In the "ARTERY Study" the effect of early initiation of antiretroviral therapy on arterial elasticity will be studied in HIV-infected patients in relation to cardiovascular outcome.…”