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Risk for Cardiovascular Disease and Regional Adipose Tissue Depots Among HIV-infected Men and Women in the Study of Fat
Redistribution and Metabolic Changes in HIV Infection (FRAM)
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Reported by Jules Levin
15th CROI, Feb 2008, Boston
David A. Wohl1, Judith Currier2, Erin Madden3, Rebecca Scherzer3, Phyllis Tien3, Steven Sydney4 and Carl Grunfeld3
1University of North Carolina - Chapel Hill, NC, USA 2University of California - Los Angeles, CA, USA 3Veterans Affairs Medical Center, San Francisco, CA, USA 34Kaiser-Permanente, Oakland, CA, USA
BACKGROUND
Several large observational studies suggest HIV+ patients are at heightened risk of CVD.
The contribution of regional adipose tissue depots to CVD risk among HIV-infected patients remains unclear. A number of studies have demonstrated an association between dyslipidemia and both lipoatrophy and lipoaccumulation but these have been small and limited to selected cohorts.
We examined the relationship between regional fat distribution and lipoprotein levels, diabetes and 10-year CVD Framingham Risk Score among participants
in the FRAM study, a representative cohort of patients under care in the US, and the CARDIA study of CVD risk in the general population.
AUTHOR CONCLUSIONS
The 10-year CVD Framingham Risk Scores were higher among HIV+ men than Control men. HIV+ and Control women had similarly low CVD risk scores.
For HIV+ group, increased VAT and decreased SAT were associated with increased CVD risk score.
For HIV+ men and women and Controls:
--Increased VAT was associated with higher triglycerides, LDL-c and lower HDL-c.
--Decreased leg SAT was associated with elevated triglycerides and non-HDL-c levels in HIV+ men and women and Controls.
In HIV+, increased VAT, total and trunk fat associated with diabetes.
The associations between regional fat and CVD factors, as well as overall CVD risk should prompt heightened CVD screening and prevention efforts for HIV+ patients with evidence of these fat distributions.
METHODS
Populations:
--HIV+men and women were recruited from 16 geographically diverse HIV/ID clinics or cohorts.
--Control men and women were participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study enrolled from 2 research clinics located at Kaiser Permanente, Oakland, CA and University of Alabama, Birmingham.
Evaluations:
--Whole-body MRI for regional fat volumes
--Cholesterol subsets including fasting (>8h) direct LDL-c, HDL-c and triglycerides
--Fasting blood glucose
--10-year CVD Framingham Risk Score
Statistical Considerations:
--Characteristics of HIV-infected participants and controls were compared and tested for statistical significance using the Mann-Whitney U test for continuous variables, and Fisher's exact test for categorical variables.
--Quartiled versions of the adipose tissue depots were created using cut offs from the control group (men and women were done separately) to facilitate comparison of similar quantities of adipose tissue.
--Associations of quartiled-depots with metabolic outcomes were tested using the Jonckheere-Terpstra and Cochran-Armitage trend tests for continuous and dichotomous outcomes respectively. HIV and Control were also compared using tests of interaction between HIV status and quartiled-depot.
--Unless otherwise specified, data from HIV+ men and women are pooled in the presented analyses
RESULTS
Table 1: Demographic & Clinical Characteristics of HIV+
and Control Subjects. This table provides interesting insights into body composition for study patients and differences between men & women. For example, total SAT was more greatly reduced among men than for women. Its also important to note that 54% of the women are African-American while 54% of the men are Caucasian. Overall, fat loss was greater among men than in women.
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