Associations between lipids and subclinical coronary atherosclerosis

Area of Science:

• Cardiovascular Medicine
• Infectious Diseases (HIV/AIDS)

Background:

• The relationship between serum lipids and coronary atherosclerosis in individuals with human immunodeficiency virus (HIV) is not fully understood.
• Understanding these associations is crucial for accurate cardiovascular disease (CVD) risk stratification in HIV-positive populations.

Purpose of the Study:

• To investigate how HIV infection modifies the association between traditional serum lipid levels and coronary atherosclerosis.
• To examine the relationship between lipids and coronary plaque subtypes in HIV-infected (HIV+) versus HIV-uninfected (HIV-) men.

Main Methods:

• Analysis of data from the Multicenter AIDS Cohort Study, including 429 HIV+ and 303 HIV- men.
• Utilized cardiac computed tomography (CCT) and coronary computed tomography angiography (CCTA) to assess coronary artery calcium, stenosis, and plaque composition.
• Employed multivariable adjusted prevalence ratios to evaluate lipid parameter associations with coronary atherosclerosis.

Main Results:

• Total cholesterol (TC)/HDL-cholesterol ratio showed the strongest association with coronary atherosclerosis in both HIV+ and HIV- men.
• Lipid parameters were most significantly linked to mixed plaque, >50% stenosis, and coronary artery calcium in both groups.
• Associations between lipids and coronary atherosclerosis were consistently weaker in HIV+ men compared to HIV- men.

Conclusions:

• While TC/HDL-cholesterol remains a key predictor, the overall weaker association between lipids and coronary atherosclerosis in HIV+ individuals may explain reduced CVD risk discrimination.
• These findings highlight potential differences in lipid metabolism and vascular disease pathogenesis in the context of HIV infection.