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Short Communication: Predictive Value of HIV-Related Versus Traditional Risk Factors for Coronary Atherosclerosis in

Branca Pereira1,2, Maria Mazzitelli1,3, Ana Milinkovic1

  • 1HIV/GUM Directorate, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.

AIDS Research and Human Retroviruses
|October 15, 2021
PubMed

Insights

Traditional risk factors like hypertension and dyslipidemia are key predictors of coronary atherosclerosis in people living with HIV (PLWH). Optimizing treatment and prevention strategies for these factors is crucial for cardiovascular health in PLWH.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • Cardiovascular disease (CVD) is a significant cause of morbidity in people living with HIV (PLWH).
  • Assessing subclinical coronary atherosclerosis is vital for risk stratification in this population.
  • Understanding the interplay of HIV-specific and traditional risk factors is crucial for effective prevention.

Purpose of the Study:

  • To compare the predictive value of HIV-related and traditional CVD risk factors for subclinical coronary atherosclerosis in PLWH.
  • To identify key predictors of coronary artery calcification (CAC) in a cohort of PLWH.
  • To inform primary prevention strategies for CVD in PLWH.

Main Methods:

  • Cross-sectional study of PLWH aged over 50 years who underwent computed tomography coronary artery calcium (CAC) scoring.
  • Analysis of outcomes including CAC=0, CAC>0, CAC>100, and CAC>400.
  • Univariate and multivariate logistic regression analyses to identify predictors of coronary calcification.

Main Results:

  • Over half of the 744 PLWH (52.7%) had evidence of coronary calcification (CAC>0).
  • Hypertension, dyslipidemia, and diabetes were strongly associated with moderate calcification (CAC>100).
  • Protease inhibitor exposure was associated with increased calcification, while tenofovir exposure showed a negative association.

Conclusions:

  • Traditional cardiometabolic risk factors are the strongest predictors of coronary atherosclerosis in PLWH.
  • There is a significant underutilization of antihypertensive and lipid-lowering therapies for primary CVD prevention in PLWH.
  • Optimizing the management of traditional risk factors and promoting primary prevention are essential for reducing CVD burden in PLWH.

Keywords:
HIVagingcoronary artery calcium scorecoronary atherosclerosishypertensionrisk factors

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