Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men

Markella V. Zanni, Suhny Abbara, Janet Lo, Bryan Wai, David Hark, Eleni Marmarelis, Steven K. Grinspoon

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Objective: Among HIV-infected patients, high rates of myocardial infarction (MI) and sudden cardiac death have been observed. Exploring potential underlying mechanisms, we used multidetector spiral coronary computed tomography angiography (coronary CTA) to compare atherosclerotic plaque morphology in HIV-infected patients and non-HIV-infected controls. Methods: Coronary atherosclerotic plaques visualized by CTA in HIV-infected (101) and non-HIV-infected (41) men without clinically apparent heart disease matched on cardiovascular risk factors were analyzed for three vulnerability features: low attenuation, positive remodeling, and spotty calcification. Results: Ninety-five percent of HIV-infected patients were receiving ART (median duration 7.9 years) and had well controlled disease (median CD4 cell count, 473 cells/μl; median HIV RNA < 50 copies/ml). Age and traditional cardiovascular risk factors were similar in HIV-infected patients and controls. Among the HIV-infected (versus control) group, there was a higher prevalence of patients with at least one: low attenuation plaque (22.8 versus 7.3%, P=0.02), positively remodeled plaque (49.5 versus 31.7%, P = 0.05) and high-risk 3-feature plaque (7.9 versus 0%, P = 0.02). Moreover, patients in the HIV-infected (versus control) group demonstrated a higher number of low attenuation plaques (P = 0.01) and positively remodeled plaques (P = 0.03) per patient. Conclusion: Our data demonstrate an increased prevalence of vulnerable plaque features among relatively young HIV-infected patients. Differences in coronary atherosclerotic plaque morphology - namely, increased vulnerable plaque among HIV-infected patients - are here for the first time reported and may contribute to increased rates of MI and sudden cardiac death in this population.

Original languageEnglish (US)
Pages (from-to)1263-1272
Number of pages10
JournalAIDS
Volume27
Issue number8
DOIs
StatePublished - May 15 2013

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Atherosclerotic Plaques
HIV
Sudden Cardiac Death
Myocardial Infarction
Computed Tomography Angiography
Control Groups
Spiral Computed Tomography
CD4 Lymphocyte Count
Heart Diseases
RNA

Keywords

  • Atherosclerosis
  • Cardiovascular disease
  • HIV
  • Myocardial infarction
  • Plaque

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men. / Zanni, Markella V.; Abbara, Suhny; Lo, Janet; Wai, Bryan; Hark, David; Marmarelis, Eleni; Grinspoon, Steven K.

In: AIDS, Vol. 27, No. 8, 15.05.2013, p. 1263-1272.

Research output: Contribution to journalArticle

Zanni, Markella V. ; Abbara, Suhny ; Lo, Janet ; Wai, Bryan ; Hark, David ; Marmarelis, Eleni ; Grinspoon, Steven K. / Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men. In: AIDS. 2013 ; Vol. 27, No. 8. pp. 1263-1272.
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T1 - Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men

AU - Zanni, Markella V.

AU - Abbara, Suhny

AU - Lo, Janet

AU - Wai, Bryan

AU - Hark, David

AU - Marmarelis, Eleni

AU - Grinspoon, Steven K.

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N2 - Objective: Among HIV-infected patients, high rates of myocardial infarction (MI) and sudden cardiac death have been observed. Exploring potential underlying mechanisms, we used multidetector spiral coronary computed tomography angiography (coronary CTA) to compare atherosclerotic plaque morphology in HIV-infected patients and non-HIV-infected controls. Methods: Coronary atherosclerotic plaques visualized by CTA in HIV-infected (101) and non-HIV-infected (41) men without clinically apparent heart disease matched on cardiovascular risk factors were analyzed for three vulnerability features: low attenuation, positive remodeling, and spotty calcification. Results: Ninety-five percent of HIV-infected patients were receiving ART (median duration 7.9 years) and had well controlled disease (median CD4 cell count, 473 cells/μl; median HIV RNA < 50 copies/ml). Age and traditional cardiovascular risk factors were similar in HIV-infected patients and controls. Among the HIV-infected (versus control) group, there was a higher prevalence of patients with at least one: low attenuation plaque (22.8 versus 7.3%, P=0.02), positively remodeled plaque (49.5 versus 31.7%, P = 0.05) and high-risk 3-feature plaque (7.9 versus 0%, P = 0.02). Moreover, patients in the HIV-infected (versus control) group demonstrated a higher number of low attenuation plaques (P = 0.01) and positively remodeled plaques (P = 0.03) per patient. Conclusion: Our data demonstrate an increased prevalence of vulnerable plaque features among relatively young HIV-infected patients. Differences in coronary atherosclerotic plaque morphology - namely, increased vulnerable plaque among HIV-infected patients - are here for the first time reported and may contribute to increased rates of MI and sudden cardiac death in this population.

AB - Objective: Among HIV-infected patients, high rates of myocardial infarction (MI) and sudden cardiac death have been observed. Exploring potential underlying mechanisms, we used multidetector spiral coronary computed tomography angiography (coronary CTA) to compare atherosclerotic plaque morphology in HIV-infected patients and non-HIV-infected controls. Methods: Coronary atherosclerotic plaques visualized by CTA in HIV-infected (101) and non-HIV-infected (41) men without clinically apparent heart disease matched on cardiovascular risk factors were analyzed for three vulnerability features: low attenuation, positive remodeling, and spotty calcification. Results: Ninety-five percent of HIV-infected patients were receiving ART (median duration 7.9 years) and had well controlled disease (median CD4 cell count, 473 cells/μl; median HIV RNA < 50 copies/ml). Age and traditional cardiovascular risk factors were similar in HIV-infected patients and controls. Among the HIV-infected (versus control) group, there was a higher prevalence of patients with at least one: low attenuation plaque (22.8 versus 7.3%, P=0.02), positively remodeled plaque (49.5 versus 31.7%, P = 0.05) and high-risk 3-feature plaque (7.9 versus 0%, P = 0.02). Moreover, patients in the HIV-infected (versus control) group demonstrated a higher number of low attenuation plaques (P = 0.01) and positively remodeled plaques (P = 0.03) per patient. Conclusion: Our data demonstrate an increased prevalence of vulnerable plaque features among relatively young HIV-infected patients. Differences in coronary atherosclerotic plaque morphology - namely, increased vulnerable plaque among HIV-infected patients - are here for the first time reported and may contribute to increased rates of MI and sudden cardiac death in this population.

KW - Atherosclerosis

KW - Cardiovascular disease

KW - HIV

KW - Myocardial infarction

KW - Plaque

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