Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy

Kristin E. Mondy, Lisa De Las Fuentes, Alan Waggoner, Nur F. Önen, Coco S. Bopp, Sherry Lassa-Claxton, William G. Powderly, Victor Dávila-Román, Kevin E. Yarasheski

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: Cardiovascular disease risk among persons with HIV is likely multifactorial, thus testing a variety of available noninvasive vascular ultrasound and other surrogate tests may yield differing results. To address this issue, we assessed multiple metabolic and clinical predictors of endothelial function and carotid intima-media thickness in HIV-infected subjects and compared results with HIV-negative controls. DESIGN: Prospective, cross-sectional study of 50 HIV-infected, healthy adults on stable highly active antiretroviral therapy matched to 50 HIV-negative controls by age, sex, race, and body mass index. METHODS: Flow-mediated vasodilation of the brachial artery, carotid intima-media thickness, dual energy X-ray absorptiometry (HIV-infected subjects), and fasting insulin, lipids, and oral glucose tolerance tests were performed. Results were compared between HIV-infected and control groups. RESULTS: Fifty percent of subjects were African-American with 34% women. Among HIV-infected, mean CD4 cell count was 547 cells/μl; 90% had HIV RNA less than 50 copies/ml. There were no significant differences between HIV-infected and control subjects with regard to brachial artery flow-mediated vasodilation or carotid intima-media thickness. In multivariate analyses of the HIV cohort, independent predictors of endothelial dysfunction (lower flow-mediated vasodilation) were increasing insulin resistance, greater alcohol consumption, and higher baseline brachial artery diameter (P < 0.05); predictors of increased carotid intima-media thickness were hypertension, higher trunk/limb fat ratio, and insulin resistance (P < 0.05). CONCLUSION: In this HIV cohort on modern highly active antiretroviral therapy with well controlled HIV, there were no significant differences with regard to preclinical markers of cardiovascular disease. Insulin resistance was a strong predictor of impaired brachial artery flow-mediated vasodilation and increased carotid intima-media thickness, and may be an important cardiovascular disease risk factor in the HIV population.

Original languageEnglish (US)
Pages (from-to)849-856
Number of pages8
JournalAIDS
Volume22
Issue number7
DOIs
StatePublished - Apr 2008

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Highly Active Antiretroviral Therapy
Insulin Resistance
HIV
Carotid Intima-Media Thickness
Brachial Artery
Vasodilation
Cardiovascular Diseases
Photon Absorptiometry
CD4 Lymphocyte Count
Glucose Tolerance Test
Alcohol Drinking
African Americans
Blood Vessels
Fasting
Body Mass Index
Multivariate Analysis
Extremities

Keywords

  • Endothelial dysfunction
  • HIV
  • Insulin resistance

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Mondy, K. E., De Las Fuentes, L., Waggoner, A., Önen, N. F., Bopp, C. S., Lassa-Claxton, S., ... Yarasheski, K. E. (2008). Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy. AIDS, 22(7), 849-856. https://doi.org/10.1097/QAD.0b013e3282f70694

Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy. / Mondy, Kristin E.; De Las Fuentes, Lisa; Waggoner, Alan; Önen, Nur F.; Bopp, Coco S.; Lassa-Claxton, Sherry; Powderly, William G.; Dávila-Román, Victor; Yarasheski, Kevin E.

In: AIDS, Vol. 22, No. 7, 04.2008, p. 849-856.

Research output: Contribution to journalArticle

Mondy, KE, De Las Fuentes, L, Waggoner, A, Önen, NF, Bopp, CS, Lassa-Claxton, S, Powderly, WG, Dávila-Román, V & Yarasheski, KE 2008, 'Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy', AIDS, vol. 22, no. 7, pp. 849-856. https://doi.org/10.1097/QAD.0b013e3282f70694
Mondy, Kristin E. ; De Las Fuentes, Lisa ; Waggoner, Alan ; Önen, Nur F. ; Bopp, Coco S. ; Lassa-Claxton, Sherry ; Powderly, William G. ; Dávila-Román, Victor ; Yarasheski, Kevin E. / Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy. In: AIDS. 2008 ; Vol. 22, No. 7. pp. 849-856.
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abstract = "OBJECTIVE: Cardiovascular disease risk among persons with HIV is likely multifactorial, thus testing a variety of available noninvasive vascular ultrasound and other surrogate tests may yield differing results. To address this issue, we assessed multiple metabolic and clinical predictors of endothelial function and carotid intima-media thickness in HIV-infected subjects and compared results with HIV-negative controls. DESIGN: Prospective, cross-sectional study of 50 HIV-infected, healthy adults on stable highly active antiretroviral therapy matched to 50 HIV-negative controls by age, sex, race, and body mass index. METHODS: Flow-mediated vasodilation of the brachial artery, carotid intima-media thickness, dual energy X-ray absorptiometry (HIV-infected subjects), and fasting insulin, lipids, and oral glucose tolerance tests were performed. Results were compared between HIV-infected and control groups. RESULTS: Fifty percent of subjects were African-American with 34{\%} women. Among HIV-infected, mean CD4 cell count was 547 cells/μl; 90{\%} had HIV RNA less than 50 copies/ml. There were no significant differences between HIV-infected and control subjects with regard to brachial artery flow-mediated vasodilation or carotid intima-media thickness. In multivariate analyses of the HIV cohort, independent predictors of endothelial dysfunction (lower flow-mediated vasodilation) were increasing insulin resistance, greater alcohol consumption, and higher baseline brachial artery diameter (P < 0.05); predictors of increased carotid intima-media thickness were hypertension, higher trunk/limb fat ratio, and insulin resistance (P < 0.05). CONCLUSION: In this HIV cohort on modern highly active antiretroviral therapy with well controlled HIV, there were no significant differences with regard to preclinical markers of cardiovascular disease. Insulin resistance was a strong predictor of impaired brachial artery flow-mediated vasodilation and increased carotid intima-media thickness, and may be an important cardiovascular disease risk factor in the HIV population.",
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T1 - Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy

AU - Mondy, Kristin E.

AU - De Las Fuentes, Lisa

AU - Waggoner, Alan

AU - Önen, Nur F.

AU - Bopp, Coco S.

AU - Lassa-Claxton, Sherry

AU - Powderly, William G.

AU - Dávila-Román, Victor

AU - Yarasheski, Kevin E.

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N2 - OBJECTIVE: Cardiovascular disease risk among persons with HIV is likely multifactorial, thus testing a variety of available noninvasive vascular ultrasound and other surrogate tests may yield differing results. To address this issue, we assessed multiple metabolic and clinical predictors of endothelial function and carotid intima-media thickness in HIV-infected subjects and compared results with HIV-negative controls. DESIGN: Prospective, cross-sectional study of 50 HIV-infected, healthy adults on stable highly active antiretroviral therapy matched to 50 HIV-negative controls by age, sex, race, and body mass index. METHODS: Flow-mediated vasodilation of the brachial artery, carotid intima-media thickness, dual energy X-ray absorptiometry (HIV-infected subjects), and fasting insulin, lipids, and oral glucose tolerance tests were performed. Results were compared between HIV-infected and control groups. RESULTS: Fifty percent of subjects were African-American with 34% women. Among HIV-infected, mean CD4 cell count was 547 cells/μl; 90% had HIV RNA less than 50 copies/ml. There were no significant differences between HIV-infected and control subjects with regard to brachial artery flow-mediated vasodilation or carotid intima-media thickness. In multivariate analyses of the HIV cohort, independent predictors of endothelial dysfunction (lower flow-mediated vasodilation) were increasing insulin resistance, greater alcohol consumption, and higher baseline brachial artery diameter (P < 0.05); predictors of increased carotid intima-media thickness were hypertension, higher trunk/limb fat ratio, and insulin resistance (P < 0.05). CONCLUSION: In this HIV cohort on modern highly active antiretroviral therapy with well controlled HIV, there were no significant differences with regard to preclinical markers of cardiovascular disease. Insulin resistance was a strong predictor of impaired brachial artery flow-mediated vasodilation and increased carotid intima-media thickness, and may be an important cardiovascular disease risk factor in the HIV population.

AB - OBJECTIVE: Cardiovascular disease risk among persons with HIV is likely multifactorial, thus testing a variety of available noninvasive vascular ultrasound and other surrogate tests may yield differing results. To address this issue, we assessed multiple metabolic and clinical predictors of endothelial function and carotid intima-media thickness in HIV-infected subjects and compared results with HIV-negative controls. DESIGN: Prospective, cross-sectional study of 50 HIV-infected, healthy adults on stable highly active antiretroviral therapy matched to 50 HIV-negative controls by age, sex, race, and body mass index. METHODS: Flow-mediated vasodilation of the brachial artery, carotid intima-media thickness, dual energy X-ray absorptiometry (HIV-infected subjects), and fasting insulin, lipids, and oral glucose tolerance tests were performed. Results were compared between HIV-infected and control groups. RESULTS: Fifty percent of subjects were African-American with 34% women. Among HIV-infected, mean CD4 cell count was 547 cells/μl; 90% had HIV RNA less than 50 copies/ml. There were no significant differences between HIV-infected and control subjects with regard to brachial artery flow-mediated vasodilation or carotid intima-media thickness. In multivariate analyses of the HIV cohort, independent predictors of endothelial dysfunction (lower flow-mediated vasodilation) were increasing insulin resistance, greater alcohol consumption, and higher baseline brachial artery diameter (P < 0.05); predictors of increased carotid intima-media thickness were hypertension, higher trunk/limb fat ratio, and insulin resistance (P < 0.05). CONCLUSION: In this HIV cohort on modern highly active antiretroviral therapy with well controlled HIV, there were no significant differences with regard to preclinical markers of cardiovascular disease. Insulin resistance was a strong predictor of impaired brachial artery flow-mediated vasodilation and increased carotid intima-media thickness, and may be an important cardiovascular disease risk factor in the HIV population.

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