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Coronary Artery Danger Signals More Common in Young HIV+ Men Than HIV- Men
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Increased Coronary Atherosclerotic Plaque Vulnerability by Coronary Computed Tomography Angiography in HIV-Infected Men - (02/11/13)......AIDS: 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. We also find a higher number of low attenuation plaques and positively remodeled plaques per patient among the HIV-infected group. In light of the potential of vulnerable plaque to rupture, resulting in clinically significant cardiac events, our results highlight a potential mechanism for heightened rates of MI's and sudden cardiac death
20th Conference on Retroviruses and Opportunistic Infections, March 3-6, 2013, Atlanta
Mark Mascolini
Three signals that coronary artery plaques may rupture proved significantly more prevalent in young HIV-positive men with relatively low cardiovascular risk than in a matched comparison group of HIV-negative men [1]. The study at Massachusetts General Hospital (MGH) is the first to pinpoint plaque danger signals with coronary computed tomography angiography (CTA) in HIV-positive men.
Previous work by the MGH team used CTA to show that young, asymptomatic, HIV-positive men had an increased prevalence and degree of coronary atherosclerosis compared with HIV-negative men [2]. Senior investigator Steven Grinspoon noted that coronary artery plaque rupture--not merely plaque presence--heralds myocardial infarction and sudden cardiac death. Research reveals three indicators of plaque vulnerability to rupture: positive remodeling, low-attenuation plaque, and spotty calcification.
This study involved 102 HIV-positive men in a Massachusetts healthcare system and 41 HIV-negative men matched to the HIV group on classic cardiovascular risk factors. No men had known heart disease. The CTA analysis focused on 2556 arterial segments in 142 men, of which 266 segments were analyzed for plaque features by radiologists blinded to HIV status.
Almost all HIV-positive men (95%) were taking antiretrovirals for an average 7.2 years. CD4 count averaged 530, and median viral load stood below 50 copies. Average age was similar in men with and without HIV (46.6 and 44.6 years), as was average Framingham risk score (7.8 and 6.2).
Two markers of plaque vulnerability were more prevalent in men with HIV than in HIV-negative controls, and the proportion of men with all three plaque markers was higher in the HIV group:
-- At least one positive-remodeling plaque: 49.5% versus 31.7%, P = 0.05
-- At least one low-attenuation plaque: 22.8% versus 7.3%, P = 0.02
-- All three plaque vulnerability markers: 7.9% versus 0%, P = 0.02
Among men with low-attenuation plaques and positively modeled plaques, men with HIV had a significantly higher number of both (P = 0.01 and P = 0.03). The difference in number of low-attenuation plaques per patient remained significant after controlling for traditional cardiovascular risk factors.
In HIV-positive men with low-attenuation plaques, the number of such plaques was associated with older age, metabolic parameters (LDL cholesterol and triglycerides), duration of antiretroviral therapy, and sCD163, a marker of macrophage activation.
Grinspoon and colleagues concluded that "heretofore unrecognized differences in coronary atherosclerotic plaque morphology [that is, increased plaque vulnerability] may contribute to increased rates of MI and sudden cardiac death" in men with HIV.
The MGH team published these findings online around the time of the Conference on Retroviruses [3].
References
1. Zanni M, Lo J, Wai B, Shah B, Hark D, Marmarelis D, Abbara S, Grinspoon S. Increased coronary atherosclerotic plaque vulnerability features on computed tomography angiography among HIV+ subjects vs matched HIV- controls. 20th Conference on Retroviruses and Opportunistic Infections. March 3-6, 2013. Atlanta. Abstract 63.
2. Lo J, Abbara S, Shturman L, et al. Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men. AIDS. 2010;24:243-253. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154841/
3. Zanni MV, Abbara S, Lo J, Wai B, Hark D, Marmarelis E, Grinspoon SK. Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men. AIDS. 2013 Jan 16. Epub ahead of print.
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