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Measures of Adipose Tissue Redistribution and Atherosclerotic Coronary Plaque in HIV
Milana Bogorodskaya1, Kathleen V Fitch2, Michael Lu3
1Division of Infectious Disease, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
Insights
Visceral adipose tissue (VAT) increases cardiovascular disease (CVD) risk in people with HIV (PWH), while subcutaneous adipose tissue (SAT) may be protective. Measuring fat distribution aids in identifying PWH at higher CVD risk.
Area of Science:
- Cardiology
- Radiology
- Infectious Diseases
Background:
- People with HIV (PWH) on antiretroviral therapy (ART) face increased risks of cardiovascular disease (CVD) and altered body composition.
- Specific relationships between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and coronary disease in PWH are not fully understood.
Purpose of the Study:
- To investigate the association between adipose tissue compartments (VAT and SAT) and coronary atherosclerosis in people with HIV (PWH).
- To determine if fat redistribution patterns predict cardiovascular disease (CVD) risk in PWH.
Main Methods:
- 148 PWH and 68 HIV-negative controls underwent abdominal CT for VAT and SAT quantification.
- Coronary artery calcium (CAC) scoring and coronary plaque composition were assessed using cardiac CT angiography.
Main Results:
- Increased VAT correlated with higher plaque presence and CAC scores in PWH.
- Increased SAT was associated with reduced plaque presence and CAC scores in PWH.
- The VAT to SAT ratio strongly predicted calcified plaque and CAC scores in PWH.
Conclusions:
- Fat redistribution, specifically increased VAT and decreased SAT, is linked to increased coronary atherosclerosis in PWH.
- Quantifying VAT and SAT can help identify PWH at elevated risk for CVD.
Objective:
People with HIV (PWH) who are well treated on antiretroviral therapy remain at increased risk for body composition changes, including increased visceral adipose tissue (VAT) and reduced subcutaneous adipose tissue (SAT), as well as increased cardiovascular disease (CVD). The relationship between adipose compartments and coronary disease is not well understood among PWH.
Methods:
A total of 148 PWH and 68 uninfected individuals without CVD were well phenotyped for VAT and SAT via single-section abdominal computed tomography (CT) at L4. Coronary artery calcium (CAC) score was assessed by noncontrast cardiac CT and coronary plaque composition by coronary CT angiography.
Results:
Increased VAT was significantly related to increased presence of plaque (OR, 1.55 per 100 cm2 ; P = 0.008) and CAC > 0 (OR, 1.56 per 100 cm2 ; P = 0.006) in the HIV group. In contrast, increased SAT was related to reduced presence of plaque (OR, 0.79 per 100 cm2 ; P = 0.057) and reduced CAC > 0 (OR, 0.69 per 100 cm2 , P = 0.007) among PWH. The VAT to SAT ratio showed a strong relationship to overall presence of calcified plaque (OR, 3.30; P = 0.03) and CAC > 0 (OR, 3.57; P < 0.001) in the HIV group. VAT and waist to hip ratio, but not SAT, were strong predictors of plaque in the uninfected group. BMI did not relate in either group.
Conclusions:
Fat redistribution phenotyping by simultaneous quantification of VAT and SAT as independent measures could help identify those PWH at higher risk for CVD.
