HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS)

P. Elliott Miller; Sabina A. Haberlen; Thomas Metkus; Panteha Rezaeian; Frank Palella; Lawrence A. Kingsley; Mallory D. Witt; Richard T. George; Lisa P. Jacobson; Todd T. Brown; Matthew Budoff; Wendy S. Post

doi:10.1016/j.atherosclerosis.2015.06.022

HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS)

P. Elliott Miller, Sabina A. Haberlen, Thomas Metkus, Panteha Rezaeian, Frank Palella, Lawrence A. Kingsley, Mallory D. Witt, Richard T. George, Lisa P. Jacobson, Todd T. Brown, Matthew Budoff, Wendy S. Post

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

Abstract

Objective: Positive remodeling (PR), a coronary artery characteristic associated with risk for myocardial infarction (MI), may be more prevalent in HIV-infected (HIV+) people. We evaluated the prevalence of PR using coronary CT angiography (CCTA) in HIV+ and HIV-uninfected (HIV-) men. Methods: Men enrolled in the Multicenter AIDS Cohort Study underwent CCTA if they were 40-70 years, had normal kidney function and no history of coronary revascularization. Multivariable logistic regression models were used to estimate the odds ratio (OR) of PR by HIV serostatus, adjusting for demographics and coronary artery disease (CAD) risk factors. Analysis of PR among atherosclerotic segments further adjusted for plaque type and stenosis. Results: The prevalence of PR was 8.4% versus 12.1% (p=0.10) for HIV- and HIV+men, respectively. After demographic adjustment, HIV+men had twice the odds of PR [OR 2.01(95% CI 1.20-3.38)], which persisted after CAD risk factor adjustment [1.76(1.00-3.10)]. Higher systolic blood pressure, total cholesterol, diabetes medication use, older age, segment number with plaque present, mixed and non-calcified plaque, and stenosis>50%, were associated with increased odds of PR, while higher HDL cholesterol, higher nadir CD4 count, and black race were associated with lower PR odds. Among atherosclerotic segments, the association between HIV infection and PR persisted, but was not statistically significantly. Conclusion: HIV+men have more positively remodeled arterial segments, which may be due to more coronary segments with atherosclerosis or HIV-related immunosuppression. Further studies are needed to evaluate whether PR contributes to higher rates of MI in HIV+individuals.

Original language	English (US)
Pages (from-to)	716-722
Number of pages	7
Journal	Atherosclerosis
Volume	241
Issue number	2
DOIs	https://doi.org/10.1016/j.atherosclerosis.2015.06.022
State	Published - Aug 1 2015

Keywords

AIDS
Coronary disease
Epidemiology
Imaging

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.atherosclerosis.2015.06.022

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@article{b1a17347fb9b4b58905db56e41c69c23,

title = "HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS)",

abstract = "Objective: Positive remodeling (PR), a coronary artery characteristic associated with risk for myocardial infarction (MI), may be more prevalent in HIV-infected (HIV+) people. We evaluated the prevalence of PR using coronary CT angiography (CCTA) in HIV+ and HIV-uninfected (HIV-) men. Methods: Men enrolled in the Multicenter AIDS Cohort Study underwent CCTA if they were 40-70 years, had normal kidney function and no history of coronary revascularization. Multivariable logistic regression models were used to estimate the odds ratio (OR) of PR by HIV serostatus, adjusting for demographics and coronary artery disease (CAD) risk factors. Analysis of PR among atherosclerotic segments further adjusted for plaque type and stenosis. Results: The prevalence of PR was 8.4% versus 12.1% (p=0.10) for HIV- and HIV+men, respectively. After demographic adjustment, HIV+men had twice the odds of PR [OR 2.01(95% CI 1.20-3.38)], which persisted after CAD risk factor adjustment [1.76(1.00-3.10)]. Higher systolic blood pressure, total cholesterol, diabetes medication use, older age, segment number with plaque present, mixed and non-calcified plaque, and stenosis>50%, were associated with increased odds of PR, while higher HDL cholesterol, higher nadir CD4 count, and black race were associated with lower PR odds. Among atherosclerotic segments, the association between HIV infection and PR persisted, but was not statistically significantly. Conclusion: HIV+men have more positively remodeled arterial segments, which may be due to more coronary segments with atherosclerosis or HIV-related immunosuppression. Further studies are needed to evaluate whether PR contributes to higher rates of MI in HIV+individuals.",

keywords = "AIDS, Coronary disease, Epidemiology, Imaging",

author = "Miller, {P. Elliott} and Haberlen, {Sabina A.} and Thomas Metkus and Panteha Rezaeian and Frank Palella and Kingsley, {Lawrence A.} and Witt, {Mallory D.} and George, {Richard T.} and Jacobson, {Lisa P.} and Brown, {Todd T.} and Matthew Budoff and Post, {Wendy S.}",

note = "Funding Information: Dr. Jacobson is a consultant for Bristol-Myers Squibb. Dr. Palella is on the speaker's bureau for Gilead Sciences, Janssen Pharmaceuticals, Merck & Co., Inc., and Bristol- Myers Squibb. Dr. Todd Brown is a consultant for Gilead Sciences, Bristol-Myers Squibb, Merck & Co., Inc., AbbVie, Theratechnologies, and ViiV Healthcare. R.T. George has received research grant support from Toshiba Medical Systems Corporation, Astellas Pharma, and GE Healthcare, and has consulted for ICON Medical Imaging. Dr. Budoff has received grant support from General Electric. The other authors have no conflicts of interest to disclose. Funding Information: The MACS CVD study is funded by NHLBI : RO1 HL095129 (Post). Data in this manuscript were collected by the MACS with centers (Principal Investigators) at: Johns Hopkins University Bloomberg School of Public Health (Joseph Margolick), U01-AI35042; Northwestern University (Steven Wolinsky), U01-AI35039; University of California, Los Angeles (Roger Detels), U01-AI35040; University of Pittsburgh (Charles Rinaldo), U01-AI35041; the Center for Analysis and Management of MACS, Johns Hopkins University Bloomberg School of Public Health (Lisa Jacobson), UM1-AI35043. The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the National Cancer Institute (NCI). MACS data collection is also supported by UL1 TR 001079 (JHU CTSA). Website located at http://www.statepi.jhsph.edu/macs/macs.html . The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2015 Elsevier Ireland Ltd.",

year = "2015",

month = aug,

day = "1",

doi = "10.1016/j.atherosclerosis.2015.06.022",

language = "English (US)",

volume = "241",

pages = "716--722",

journal = "Atherosclerosis",

issn = "0021-9150",

publisher = "Elsevier Ireland Ltd",

number = "2",

}

TY - JOUR

T1 - HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS)

AU - Miller, P. Elliott

AU - Haberlen, Sabina A.

AU - Metkus, Thomas

AU - Rezaeian, Panteha

AU - Palella, Frank

AU - Kingsley, Lawrence A.

AU - Witt, Mallory D.

AU - George, Richard T.

AU - Jacobson, Lisa P.

AU - Brown, Todd T.

AU - Budoff, Matthew

AU - Post, Wendy S.

N1 - Funding Information: Dr. Jacobson is a consultant for Bristol-Myers Squibb. Dr. Palella is on the speaker's bureau for Gilead Sciences, Janssen Pharmaceuticals, Merck & Co., Inc., and Bristol- Myers Squibb. Dr. Todd Brown is a consultant for Gilead Sciences, Bristol-Myers Squibb, Merck & Co., Inc., AbbVie, Theratechnologies, and ViiV Healthcare. R.T. George has received research grant support from Toshiba Medical Systems Corporation, Astellas Pharma, and GE Healthcare, and has consulted for ICON Medical Imaging. Dr. Budoff has received grant support from General Electric. The other authors have no conflicts of interest to disclose. Funding Information: The MACS CVD study is funded by NHLBI : RO1 HL095129 (Post). Data in this manuscript were collected by the MACS with centers (Principal Investigators) at: Johns Hopkins University Bloomberg School of Public Health (Joseph Margolick), U01-AI35042; Northwestern University (Steven Wolinsky), U01-AI35039; University of California, Los Angeles (Roger Detels), U01-AI35040; University of Pittsburgh (Charles Rinaldo), U01-AI35041; the Center for Analysis and Management of MACS, Johns Hopkins University Bloomberg School of Public Health (Lisa Jacobson), UM1-AI35043. The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the National Cancer Institute (NCI). MACS data collection is also supported by UL1 TR 001079 (JHU CTSA). Website located at http://www.statepi.jhsph.edu/macs/macs.html . The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health. Publisher Copyright: © 2015 Elsevier Ireland Ltd.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Objective: Positive remodeling (PR), a coronary artery characteristic associated with risk for myocardial infarction (MI), may be more prevalent in HIV-infected (HIV+) people. We evaluated the prevalence of PR using coronary CT angiography (CCTA) in HIV+ and HIV-uninfected (HIV-) men. Methods: Men enrolled in the Multicenter AIDS Cohort Study underwent CCTA if they were 40-70 years, had normal kidney function and no history of coronary revascularization. Multivariable logistic regression models were used to estimate the odds ratio (OR) of PR by HIV serostatus, adjusting for demographics and coronary artery disease (CAD) risk factors. Analysis of PR among atherosclerotic segments further adjusted for plaque type and stenosis. Results: The prevalence of PR was 8.4% versus 12.1% (p=0.10) for HIV- and HIV+men, respectively. After demographic adjustment, HIV+men had twice the odds of PR [OR 2.01(95% CI 1.20-3.38)], which persisted after CAD risk factor adjustment [1.76(1.00-3.10)]. Higher systolic blood pressure, total cholesterol, diabetes medication use, older age, segment number with plaque present, mixed and non-calcified plaque, and stenosis>50%, were associated with increased odds of PR, while higher HDL cholesterol, higher nadir CD4 count, and black race were associated with lower PR odds. Among atherosclerotic segments, the association between HIV infection and PR persisted, but was not statistically significantly. Conclusion: HIV+men have more positively remodeled arterial segments, which may be due to more coronary segments with atherosclerosis or HIV-related immunosuppression. Further studies are needed to evaluate whether PR contributes to higher rates of MI in HIV+individuals.

AB - Objective: Positive remodeling (PR), a coronary artery characteristic associated with risk for myocardial infarction (MI), may be more prevalent in HIV-infected (HIV+) people. We evaluated the prevalence of PR using coronary CT angiography (CCTA) in HIV+ and HIV-uninfected (HIV-) men. Methods: Men enrolled in the Multicenter AIDS Cohort Study underwent CCTA if they were 40-70 years, had normal kidney function and no history of coronary revascularization. Multivariable logistic regression models were used to estimate the odds ratio (OR) of PR by HIV serostatus, adjusting for demographics and coronary artery disease (CAD) risk factors. Analysis of PR among atherosclerotic segments further adjusted for plaque type and stenosis. Results: The prevalence of PR was 8.4% versus 12.1% (p=0.10) for HIV- and HIV+men, respectively. After demographic adjustment, HIV+men had twice the odds of PR [OR 2.01(95% CI 1.20-3.38)], which persisted after CAD risk factor adjustment [1.76(1.00-3.10)]. Higher systolic blood pressure, total cholesterol, diabetes medication use, older age, segment number with plaque present, mixed and non-calcified plaque, and stenosis>50%, were associated with increased odds of PR, while higher HDL cholesterol, higher nadir CD4 count, and black race were associated with lower PR odds. Among atherosclerotic segments, the association between HIV infection and PR persisted, but was not statistically significantly. Conclusion: HIV+men have more positively remodeled arterial segments, which may be due to more coronary segments with atherosclerosis or HIV-related immunosuppression. Further studies are needed to evaluate whether PR contributes to higher rates of MI in HIV+individuals.

KW - AIDS

KW - Coronary disease

KW - Epidemiology

KW - Imaging

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U2 - 10.1016/j.atherosclerosis.2015.06.022

DO - 10.1016/j.atherosclerosis.2015.06.022

M3 - Article

C2 - 26132282

AN - SCOPUS:84934978035

SN - 0021-9150

VL - 241

SP - 716

EP - 722

JO - Atherosclerosis

JF - Atherosclerosis

IS - 2

ER -

HIV and coronary arterial remodeling from the Multicenter AIDS Cohort Study (MACS)

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