CCTA Reveals Higher Coronary Plaque Incidence with HIV

Patients who are HIV-positive – even those who are at low-to-moderate risk for cardiovascular disease – have more coronary plaque, according to research conducted with coronary CT angiography (CCTA).

In a study published June 29 in JAMA Network Open, investigators from Massachusetts General Hospital (MGH) revealed this risk and suggested that additional research into how statin therapy could benefit this group would be critical.

“This study found a substantial prevalence of coronary artery disease even in young people with HIV with low traditional atherosclerotic cardiovascular disease risk,” said the team led by Udo Hoffman, M.D., an MGH cardiac radiologist. “Key markers of innate immune activation and arterial inflammation were associated with coronary artery disease in this group with well-controlled HIV disease, independent of traditional risk factors.”

Even though the increased risk for cardiovascular disease among people with HIV has been well documented, it has been less clear how frequently low-to-moderate risk individuals in this group also experience coronary artery disease. To find answers, Hoffman’s team used CCTA to assess the factors linked to cardiovascular disease in this patient population and evaluate the coronary artery disease they experienced.

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For this study, they enrolled 755 HIV-positive men and women who had no known cardiovascular disease. All participants had low-to-moderate cardiovascular risk, were between ages 40-to-75, and were all receiving anti-retroviral therapy. The team pulled data from the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) from May 2015 to February 2018.

Using this information, Hoffman’s group examined CCTA scans to assess the prevalence and composition of coronary artery disease, focusing on the degree of stenosis and atherosclerotic plaque. They also investigated any links between cardiovascular disease biomarkers, including insulin, interleukin-6, lipo-protein, and C-reactive protein, and coronary artery disease.

Based on their evaluations, the team determined that 49 percent of participants had plaque. More concerning, they said, 30 percent of the patients who had a cardiovascular disease risk of less than 2.5 percent also had plaque. In addition, they found that 35 percent of patients had coronary artery calcium scores greater than 0.

Overall, they found that participants were plaque tended to be older, male, and African American. They also had a higher prevalence of hypertension, as well as a family history of premature coronary artery disease, and they had higher cholesterol and glucose levels.

Ultimately, the team determined, their findings support more vigilant monitoring for cardiovascular disease among HIV-positive patients.

“Plaque characteristics in this group suggest a low prevalence of significant stenosis, but vulnerable plaque characteristics were seen in nearly one-quarter,” they said. “It will be critical in future studies to determine how this unique plaque phenotype related to major adverse cardiovascular events over time.”

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