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Lower coronary plaque burden in patients with HIV presenting with acute coronary syndrome

E J O'Dwyer1, P Bhamra-Ariza2, S Rao3

  • 1St. Vincent's Hospital Darlinghurst and the University of New South Wales, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.

Open Heart
|January 27, 2017
PubMed

Insights

Men with HIV and acute coronary syndrome paradoxically showed less coronary plaque burden than controls. This suggests plaque vulnerability, not just plaque amount, drives coronary artery disease in HIV-infected men.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Vascular Biology

Background:

  • Treated HIV infection is linked to increased coronary artery disease (CAD) and myocardial infarction.
  • The underlying mechanisms for this increased CAD risk in HIV-infected individuals remain incompletely understood.

Purpose of the Study:

  • To investigate the coronary artery disease burden in men with HIV presenting with acute coronary syndrome (ACS).
  • To compare coronary plaque characteristics between HIV-infected men and age-matched controls with ACS.

Main Methods:

  • Retrospective analysis of invasive coronary angiograms from 160 men with ACS (73 HIV-infected, 87 controls).
  • Coronary disease burden assessed using the Gensini Angiographic Scoring System by blinded cardiologists.
  • Comparison of demographic data, risk factors, and Gensini scores between HIV-infected patients and controls.

Main Results:

  • HIV-infected men used more antihypertensives and statins than controls.
  • No significant difference in plaque distribution was observed between groups.
  • The Gensini score was 42% lower in HIV-infected men compared to controls (p<0.03).
  • C-reactive protein levels were higher in HIV-infected cases.

Conclusions:

  • Men with HIV presenting with ACS exhibited a paradoxically lower burden of coronary plaque compared to matched controls.
  • Despite more aggressive risk factor management, HIV-infected men had less plaque.
  • Plaque vulnerability, rather than total atherosclerotic burden, may be a key factor in CAD pathophysiology among men with HIV.
Abstract

Keywords:
CORONARY ARTERY DISEASE

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