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Greater carotid intima media thickness at a younger age in HIV-infected patients compared with reference values for
M Krikke1, J E Arends1, Sfl Van Lelyveld1,2
1Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
Insights
HIV-infected patients exhibit increased carotid artery intima media thickness (CIMT) compared to controls. Traditional cardiovascular disease (CVD) risk factors, not HIV-specific ones, are linked to this increased CIMT, guiding preventive strategies.
Area of Science:
- Cardiology
- Infectious Diseases
- Vascular Biology
Background:
- Cardiovascular disease (CVD) progression in HIV-infected individuals differs from the general population, showing no recent decline.
- HIV infection may influence vascular health, necessitating investigation into specific risk factors.
- Carotid artery intima media thickness (CIMT) serves as a key biomarker for subclinical atherosclerosis.
Purpose of the Study:
- To compare CIMT in HIV-infected patients with age- and gender-matched controls.
- To identify associations between cardiovascular risk factors and CIMT in the HIV-infected cohort.
- To determine the relative impact of HIV-specific versus classical CVD risk factors on CIMT.
Main Methods:
- A cohort of 292 HIV-infected patients underwent vascular screening, including CIMT measurement.
- Data on classical CVD risk factors (hypertension, diabetes, smoking) and HIV-specific variables were collected.
- Linear regression analysis, adjusted for age, gender, and HIV status, was used to evaluate associations with CIMT.
Main Results:
- HIV-infected patients demonstrated significantly greater CIMT (0.77 ± 0.19 mm) compared to controls (0.58 ± 0.05 mm).
- A steeper increase in CIMT with age was observed in the HIV-infected group.
- Hypertension, diabetes mellitus, smoking, systolic blood pressure, HbA1c, and ankle-brachial index were significantly associated with increased CIMT.
Conclusions:
- HIV-infected patients exhibit increased subclinical atherosclerosis, evidenced by greater CIMT.
- Classical cardiovascular risk factors are more strongly associated with CIMT than HIV-specific variables in this cohort.
- Preventive strategies for CVD in HIV-infected patients should prioritize management of traditional risk factors.
Objectives:
In contrast to the general population, no decline in cardiovascular disease (CVD) has been noted in HIV-infected patients over the last 10 years. We compared the carotid artery intima media thickness (CIMT) of HIV-infected patients to that of age- and gender-matched reference values and determined the relationship between CVD risk factors and CIMT.
Methods:
A total of 292 HIV-infected patients were enrolled in the study. Data collected included vascular screening data, data obtained using a questionnaire, data obtained from laboratory assessments and CIMT measurement. Using linear regression (adjusted for age/gender/known HIV), the association between HIV-specific and classical cardiovascular risk factors and CIMT was evaluated.
Results:
The cohort comprised for 91% of male patients, aged 49.4 ± 10.5 years, with a known duration of HIV infection of 8.8 ± 6.7 years. The mean with standard deviation (mean ± SD) CIMT was 0.77 ± 0.19 mm, compared with 0.58 ± 0.05 mm in the controls. A steeper increase of CIMT per age was seen in the HIV-infected patients. A significant relationship between CIMT and hypertension, diabetes mellitus, smoking, systolic blood pressure, HbA1c (glycated hemoglobin) and ankle brachial index was found. Of the HIV-specific variables, only a relationship between CIMT and length of cART use and between CIMT and (inversely) current cART use was seen.
Conclusions:
A greater CIMT was found in HIV-infected patients compared with controls. In contrast to HIV-specific variables, classical CVD risk factors were associated with a greater CIMT and should therefore be the focus of preventive measures.
