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Comparison of racial differences in plaque composition and stenosis between HIV-positive and HIV-negative men from
P Elliott Miller1, Matthew Budoff2, Michelle Zikusoka1
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Black men have less coronary artery calcification (CAC) and stenosis than white men, but similar overall plaque prevalence. This suggests reduced plaque calcification, not less plaque, contributes to lower CAC in Black individuals.
Area of Science:
- Cardiovascular imaging
- Racial disparities in health
- HIV research
Background:
- Previous studies indicate Black individuals have lower coronary artery calcification (CAC) than White individuals.
- Understanding racial differences in plaque composition and severity is crucial for cardiovascular risk assessment.
Purpose of the Study:
- To investigate racial differences in coronary artery plaque composition, calcification, and stenosis among men in the Multicenter AIDS Cohort Study.
- To determine if observed differences are related to HIV status and cardiovascular risk factors.
Main Methods:
- 1,001 HIV-positive and HIV-negative men (aged 40-70) underwent cardiac computed tomography (CT).
- Coronary CT angiography (CTA) was performed on 759 men to assess total plaque, noncalcified plaque, calcified plaque, and stenosis >50%.
- Statistical analyses adjusted for HIV serostatus, cardiovascular risk factors, and socioeconomic status.
Main Results:
- Black men showed lower prevalences of CAC, calcified plaque, and significant stenosis (>50%) compared to White men.
- No significant difference in the prevalence of any plaque or noncalcified plaque was observed between racial groups.
- Black race was associated with a lower extent of plaque in HIV-positive men but not in HIV-negative men.
Conclusions:
- Lower CAC prevalence in Black men is primarily due to less calcification within plaques and less severe stenosis, not a lower overall plaque burden.
- These findings highlight the complexity of racial disparities in atherosclerosis and the importance of considering plaque characteristics.
Abstract:
Previous studies demonstrated that blacks have less coronary artery calcification (CAC) than whites. We evaluated racial differences in plaque composition and stenosis in the Multicenter AIDS Cohort Study. HIV-positive and HIV-negative men underwent noncontrast cardiac computed tomography (CT) if they were aged 40 to 70 years, weighed <136 kg, and had no history of cardiac surgery or revascularization and, if eligible, coronary CT angiography (CTA). There were 1,001 men who underwent CT scans and 759 men CTA. We measured CAC on noncontrast CT and identified total plaque, noncalcified plaque, calcified plaque, mixed plaque, and coronary stenosis >50% on CTA. The association of presence and extent of plaque with race was determined after adjustment for HIV serostatus, cardiovascular risk factors, and measures of socioeconomic status. The prevalences of any plaque on CTA and noncalcified plaque were not different between black and white men; however, black men had lower prevalences of CAC (prevalence ratio [PR] 0.79, p = 0.01), calcified plaque (PR 0.69, p = 0.002), and stenosis >50% (PR 0.59, p = 0.009). There were no associations between black race and extent of plaque in fully adjusted models. Using log-linear regression, black race was associated with a lower extent of any plaque on CTA in HIV-positive men (estimate = -0.24, p = 0.051) but not in HIV-negative men (0.12, p = 0.50, HIV interaction p = 0.005). In conclusion, a lower prevalence of CAC in black compared with white men appears to reflect less calcification of plaque and stenosis rather than a lower overall prevalence of plaque.