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

Markella V Zanni1, Suhny Abbara, Janet Lo

  • 1Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. mzanni@partners.org

AIDS (London, England)
|January 18, 2013
PubMed

Insights

HIV-infected patients show more vulnerable coronary artery plaque features, potentially explaining higher rates of heart attack and sudden cardiac death. This study highlights differences in atherosclerotic plaque morphology in this population.

Area of Science:

  • Cardiovascular disease research
  • HIV/AIDS research
  • Medical imaging

Background:

  • HIV infection is linked to increased risks of myocardial infarction (MI) and sudden cardiac death.
  • Underlying mechanisms for these cardiovascular events in HIV patients require further investigation.
  • Coronary computed tomography angiography (coronary CTA) can assess atherosclerotic plaque characteristics.

Purpose of the Study:

  • To compare atherosclerotic plaque morphology between HIV-infected patients and non-HIV-infected controls using coronary CTA.
  • To identify specific plaque vulnerability features associated with HIV infection.

Main Methods:

  • Coronary CTA was used to visualize plaques in 101 HIV-infected and 41 non-HIV-infected men.
  • Participants were matched for cardiovascular risk factors and had no apparent heart disease.
  • Plaques were analyzed for low attenuation, positive remodeling, and spotty calcification.

Main Results:

  • HIV-infected patients, even on effective antiretroviral therapy (ART), showed a higher prevalence of low attenuation plaque (22.8% vs 7.3%) and positively remodeled plaque (49.5% vs 31.7%).
  • A higher proportion of HIV-infected patients had high-risk 3-feature plaques (7.9% vs 0%).
  • The number of low attenuation and positively remodeled plaques per patient was significantly higher in the HIV-infected group.

Conclusions:

  • HIV-infected patients exhibit an increased prevalence of vulnerable coronary atherosclerotic plaque features.
  • These morphological differences in plaques are reported for the first time and may underlie the elevated risk of MI and sudden cardiac death in this population.
  • Further research into HIV-related cardiovascular pathology is warranted.
Abstract

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