Assessment of Coronary Artery Disease With Computed Tomography Angiography and Inflammatory and Immune Activation Biomarkers Among Adults With HIV Eligible for Primary Cardiovascular Prevention.

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  • Additional Information
    • Corporate Authors:
    • Source:
      Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
    • Publication Information:
      Original Publication: Chicago, IL : American Medical Association, [2018]-
    • Subject Terms:
    • Abstract:
      Importance: Cardiovascular disease (CVD) is increased among people with HIV (PWH), but little is known regarding the prevalence and extent of coronary artery disease (CAD) and associated biological factors in PWH with low to moderate traditional CVD risk.
      Objectives: To determine unique factors associated with CVD in PWH and to assess CAD by coronary computed tomography angiography (CTA) and critical pathways of arterial inflammation and immune activation.
      Design, Setting, and Participants: This cohort study among male and female PWH, aged 40 to 75 years, without known CVD, receiving stable antiretroviral therapy, and with low to moderate atherosclerotic cardiovascular disease (ASCVD) risk according to the 2013 American College of Cardiology/American Heart Association pooled cohort equation, was part of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), a large, ongoing primary prevention trial of statin therapy among PWH conducted at 31 US sites. Participants were enrolled from May 2015 to February 2018. Data analysis was conducted from May to December 2020.
      Exposure: HIV disease.
      Main Outcomes and Measures: The primary outcome was the prevalence and composition of CAD assessed by coronary CTA and, secondarily, the association of CAD with traditional risk indices and circulating biomarkers, including insulin, monocyte chemoattractant protein 1 (MCP-1), interleukin (IL) 6, soluble CD14 (sCD14), sCD163, lipoprotein-associated phospholipase A2 (LpPLA2), oxidized low-density lipoprotein (oxLDL), and high-sensitivity C-reactive protein (hsCRP).
      Results: The sample included 755 participants, with a mean (SD) age of 51 (6) years, 124 (16%) female participants, 267 (35%) Black or African American participants, 182 (24%) Latinx participants, a low median (interquartile range) ASCVD risk (4.5% [2.6%-6.8%]), and well-controlled viremia. Overall, plaque was seen in 368 participants (49%), including among 52 of 175 participants (30%) with atherosclerotic CVD (ASCVD) risk of less than 2.5%. Luminal obstruction of at least 50% was rare (25 [3%]), but vulnerable plaque and high Leaman score (ie, >5) were more frequently observed (172 of 755 [23%] and 118 of 743 [16%], respectively). Overall, 251 of 718 participants (35%) demonstrated coronary artery calcium score scores greater than 0. IL-6, LpPLA2, oxLDL, and MCP-1 levels were higher in those with plaque compared with those without (eg, median [IQR] IL-6 level, 1.71 [1.05-3.04] pg/mL vs 1.45 [0.96-2.60] pg/mL; P = .008). LpPLA2 and IL-6 levels were associated with plaque in adjusted modeling, independent of traditional risk indices and HIV parameters (eg, IL-6: adjusted odds ratio, 1.07; 95% CI, 1.02-1.12; P = .01).
      Conclusions and Relevance: In this study of a large primary prevention cohort of individuals with well-controlled HIV and low to moderate ASCVD risk, CAD, including noncalcified, nonobstructive, and vulnerable plaque, was highly prevalent. Participants with plaque demonstrated higher levels of immune activation and arterial inflammation, independent of traditional ASCVD risk and HIV parameters.
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    • Grant Information:
      P30 DK040561 United States DK NIDDK NIH HHS; UM1 AI069470 United States AI NIAID NIH HHS; U01 HL123339 United States HL NHLBI NIH HHS; UM1 AI069463 United States AI NIAID NIH HHS; U01 HL123336 United States HL NHLBI NIH HHS; UM1 AI069511 United States AI NIAID NIH HHS; UM1 AI068636 United States AI NIAID NIH HHS; UM1 AI069494 United States AI NIAID NIH HHS; UM1 AI069423 United States AI NIAID NIH HHS
    • Contributed Indexing:
      Investigator: A Khodabakhshian; A Sbrolla; BE Sha; CL Costanza; CA Hawkins; C Reynolds; CN Van Dam; D Berrner; D Choi; JL Nemeth; JM Jacobson; J Gottesman; J Dwyer; JR Koethe; JL Santana; J Pasternak; KS Ho; ME Sobieszczyk; M Mall; MS Huaman; Q Truong; R Fry; RT O'Donnell; RC Arduino; R Chinchay Collahua; S Barcavage; S Swaminathan; S Perez-Frontera; T Stroberg
    • Accession Number:
      0 (Biomarkers)
    • Publication Date:
      Date Created: 20210629 Date Completed: 20220105 Latest Revision: 20221110
    • Publication Date:
      20231215
    • Accession Number:
      PMC8243232
    • Accession Number:
      10.1001/jamanetworkopen.2021.14923
    • Accession Number:
      34185068