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Age Raises Rate of Dangerous Coronary Artery Plaques in HIV+ But Not HIV- MACS Men
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Increased Coronary Atherosclerotic Plaque Vulnerability by Coronary Computed Tomography Angiography in HIV-Infected Men - (02/11/13)....AIDS: POST ACCEPTANCE, 16 January 2013.....Grinspoon, Steven K et al.........We find an increased prevalence of plaque vulnerability - including low attenuation plaque, positively remodeled plaque, and high-risk 3-feature positive plaque - among HIV-infected patients versus controls with similar traditional cardiovascular risk factors
20th Conference on Retroviruses and Opportunistic Infections, March 3-6, 2013, Atlanta
Mark Mascolini
Chances of having a dangerous noncalcified coronary artery plaque ran almost 75% higher in HIV-positive men in the Multicenter AIDS Cohort Study (MACS) than in HIV-negative MACS men [1]. Noncalcified plaque prevalence rose with age in HIV-positive men but not HIV-negative men. Prevalence of stable calcified plaques rose steadily with age in both HIV-positive and negative men.
Heart experts consider noncalcified coronary plaques more dangerous that calcified plaques because the noncalcified type may be more prone to rupture. Noncalcified plaques represent the earliest stage of atherosclerosis. Previous work by MACS investigators found a higher prevalence of noncalcified plaques in HIV-positive MACS men than in HIV-negative men [2].
In the new study MACS investigators compared cardiovascular risk factors and used coronary CT angiography to assess arteries of 571 HIV-positive and 302 HIV-negative MACS members between 40 and 70 years old. They used multivariable logistic regression analysis to explore associations between cardiovascular risks factors and presence of any plaque--noncalcified, mixed, or calcified. All statistical models adjusted for age and race. The analysis excluded men with a history of cardiac surgery, coronary angioplasty, or weight above 300 pounds.
HIV-positive men were significantly younger than the seronegative group (53.3 versus 55.8 years, P < 0.0001), and the HIV group had a significantly lower body mass index (26.1 versus 27.4 kg/m(2), P = 0.0003). Higher proportions of men with HIV had hypertension (49.7% versus 44.3%, P = 0.13) or diabetes (14.3% versus 10.4%, P = 0.11), though those differences did not reach statistical significance. More HIV-positive than negative men were current smokers (32% versus 21%, P = 0.0007). The HIV group had significantly lower LDL cholesterol but significantly higher triglycerides.
Nearly all HIV-positive men (96%) were taking antiretrovirals, and most (81%) had a viral load below 50 copies. Median CD4 count stood at 593, and median antiretroviral duration was 12.3 years.
In an analysis that adjusted for age, race, and cardiovascular risk factors, HIV-positive men had higher odds of coronary artery calcium, any plaque, noncalcified plaque, and mixed plaque--but not calcified plaque--at the following odds ratios (OR):
-- Coronary artery calcium: OR 1.42, P = 0.04
-- Any plaque: OR 1.80, P = 0.009
-- Noncalcified plaque: OR 1.77, P = 0.002
-- Mixed plaque: OR 1.47, P = 0.053
Compared with HIV-negative men, HIV-positive men had a worse noncalcified plaque score in analyses that adjusted for age and race, or age, race, and cardiovascular risk factors (parameter estimate 0.17, P = 0.02 for both analyses).
Prevalence of coronary artery calcium or calcified plaque did not differ significantly by age between HIV-positive and HIV-negative men. Calcified plaque prevalence rose with age in both HIV-positive and negative men. But prevalence of noncalcified plaque was significantly greater by age in HIV-positive than negative men (adjusted prevalence ratio HIV+/HIV- 1.23, P = 0.002). Similar proportions of HIV-positive and negative men between 40 and 44 and between 45 and 49 had noncalcified plaques. But noncalcified plaque prevalence continued to rise with age in HIV-positive men, while remaining largely stable in HIV-negative men:
-- 40 to 44 years: 22% HIV+ versus 24% HIV-
-- 45 to 49 years: 56% HIV+ versus 58% HIV-
-- 50 to 54 years: 73% HIV+ versus 54% HIV-
-- 55 to 59 years: 80% HIV+ versus 76% HIV-
-- 60 to 64 years: 67% HIV+ versus 54% HIV-
-- 65 to 70 years: 92% HIV+ versus 53% HIV-
The MACS investigators believe their findings "may have implications for the risk of myocardial infarction and the optimal timing of cardiovascular disease screening for aging HIV-positive persons."
References
1. Post W, Jacobson L, Li X, et al. Age and Noncalcified coronary plaque in the Multicenter AIDS Cohort Study. 20th Conference on Retroviruses and Opportunistic Infections. March 3-6, 2013. Atlanta. Abstract 62.
2. Post W, Jacobson L, Li X, Palella et al, and the Multicenter AIDS Cohort Study. HIV infection is associated with greater amounts of non-calcified coronary artery plaque: MACS. 19th Conference on Retroviruses and Opportunistic Infections. March 5-8, 2012. Seattle. Abstract 809. http://www.natap.org/2012/CROI/croi_26.htm.
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