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Fat Changes Boost Heart Disease and Diabetes Risk in HIV-Infected Men
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(Poster online at http://www.retroconference.org/2008/PDFs/956.pdf.)
15th Conference on Retroviruses and Opportunistic Infections
February 3-6, 2008
Boston
Mark Mascolini
The study authors concluded:
"For HIV+ group, increased VAT (belly fat) and decreased SAT (fat loss, lipoatrophy) were associated with increased CVD (cardiovascular) 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."
In HIV-infected men in the FRAM study of regional fat abnormalities, a new analysis linked high belly fat (visceral adipose tissue, or VAT) and lower leg fat (subcutaneous adipose tissue, or SAT) to a higher Framingham Risk Score for cardiovascular disease [1]. The study also tied high total fat, upper trunk SAT, and belly fat to a higher risk of diabetes in men and women with HIV.
Earlier FRAM reports demonstrated that arm and leg fat wasting (lipoatrophy)--but not excess central or neck fat--distinguished US residents with HIV from age-matched controls in the general population [2]. FRAM also linked VAT and upper trunk SAT to insulin resistance in HIV-infected people and controls [3]. The new analysis probed potential links between regional fat distribution, lipid levels, diabetes, and 10-year Framingham heart disease risk score. This investigation compared 408 men with HIV and 147 age-related control men, and 178 women with HIV and 133 age-related controls. The researchers measured regional fat by whole-body magnetic resonance imaging and divided fat volumes into quartiles (equal quarters) using cutoffs derived from the control groups of men and women.
The HIV group included slightly but significantly more white men than the control group (57% versus 55%, P = 0.043) and significantly fewer HIV-infected white women (33% versus 50%, P = 0.043). Compared with controls, significantly more women and men with HIV smoked when they signed up for FRAM (P < 0.0001 for both genders), but hypertension rates were similar in the HIV and control groups for both men (about 15% to 20%) and women (about 10% to 15%).
More belly fat (VAT) and upper trunk subcutaneous fat (SAT) correlated with higher triglycerides in both in the HIV group and the control group. But lower leg SAT correlated with high triglycerides only among HIV-infected people (P < 0.0001). Increased VAT and upper trunk SAT and lower leg SAT correlated with higher ("bad") low-density lipoprotein (LDL) cholesterol and lower ("good") high-density lipoprotein (HDL) cholesterol in the non-HIV group. But only higher VAT meant higher LDL cholesterol in people with HIV (P < 0.0001), and none of these body fat readings predicted low HDL in the HIV group.
The FRAM team tied higher total fat (P = 0.017), VAT (P < 0.0001), and upper trunk SAT (P < 0.0001)--but not lower leg SAT (P = 0.56)--to higher diabetes rates in people with HIV. In the HIV group higher VAT and lower leg SAT correlated with a worse 10-year Framingham heart risk score (P < 0.0001 for both correlations). HIV-infected men had higher 10-year Framingham scores than control men, but women with and without HIV had similarly low risk scores.
The investigators believe "the associations between regional fat and cardiovascular risk factors, as well as overall cardiovascular risk, should prompt heightened cardiovascular screening and prevention efforts for HIV+ patients with evidence of these fat distributions."
References
1. Wohl D, J Currier J, Madden E, Scherzer R, Tien P, Grunfeld C. 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. 15th Conference on Retroviruses and Opportunistic Infections. February 3-6, 2008. Boston. Abstract 956.
2. Bacchetti P, Gripshover B, Grunfeld C, et al. Fat distribution in men with HIV infection. J Acquir Immune Defic Syndr. 2005;40:121-31.
3. Grunfeld C, Rimland D, Gibert CL, et al. Association of upper trunk and visceral adipose tissue volume with insulin resistance in control and HIV-infected subjects in the FRAM study. J Acquir Immune Defic Syndr. 2007;46:283-390.
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