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Coronary Endothelial Dysfunction in People Living With HIV Is Related to Body Fat Distribution
Erin Goerlich1, Michael Schär2, Shashwatee Bagchi3
1Division of Cardiology, Johns Hopkins University, Baltimore, MD.
Insights
Body fat distribution, including waist and hip measurements and subcutaneous fat, is linked to impaired coronary artery endothelial function (CEF) in people living with HIV (PLWH) on antiretroviral therapy (ART). This finding may explain the higher heart disease risk in PLWH.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- People living with HIV (PLWH) on antiretroviral therapy (ART) face elevated risks of atherosclerotic disease.
- Abnormal adipose tissue distribution is prevalent in PLWH and may promote atherosclerosis.
- Coronary artery endothelial function (CEF) impairment is an early sign of atherosclerosis and a predictor of cardiovascular events, and it is reduced in PLWH.
Purpose of the Study:
- To investigate the associations between body fat distribution and coronary artery endothelial function (CEF) in people living with HIV (PLWH).
Main Methods:
- A prospective cohort study involving 84 PLWH on stable ART.
- Magnetic Resonance Imaging (MRI) was used to quantify CEF and abdominal fat distribution (visceral and subcutaneous) and liver fat fraction.
- Linear regression models were employed to analyze the relationships between CEF and body fat measurements.
Main Results:
- Impaired CEF was observed in the study population (mean cross-sectional area change: 0.74 ± 11.7%).
- Univariable analysis revealed inverse associations between CEF and waist circumference, hip circumference, and subcutaneous fat area.
- Multivariable regression, adjusted for age, sex, and race, showed CEF was associated with waist circumference, hip circumference, subcutaneous fat, and liver fat fraction.
Conclusions:
- Waist and hip circumference and subcutaneous fat area are associated with impaired CEF in PLWH on ART.
- These associations may contribute to the increased incidence of heart disease observed in this population.
- Body fat distribution is a significant factor in vascular health among PLWH.
Background:
People living with HIV (PLWH) on antiretroviral therapy (ART) are at increased risk of atherosclerotic disease. Abnormal adipose distribution is common in PLWH and may contribute to atherosclerosis. Because coronary artery endothelial function (CEF) is impaired in early atherosclerosis, predicts future cardiovascular events, and is reduced in PLWH, we investigated associations between body fat distribution and CEF in PLWH.
Setting:
Prospective cohort study.
Methods:
PLWH on stable ART underwent MRI to quantify CEF, measured as change in coronary cross-sectional area from rest to that during isometric handgrip exercise, an endothelial-dependent stressor. Abdominal visceral and subcutaneous fat area (axial L4 level) and liver fat fraction were quantified using MRI. Linear regression was used to determine associations between CEF and independent variables.
Results:
Among 84 PLWH (52 ± 11 years; 33% women), mean cross-sectional area change was 0.74 ± 11.7%, indicating impaired CEF. On univariable regression analysis, CEF was inversely related to waist circumference (R = -0.31, P = 0.014), hip circumference (R = -0.27, P = 0.037), and subcutaneous fat area (R = -0.25, P = 0.031). We did not observe significant relationships between CEF and liver fat fraction, waist/hip ratio, or visceral fat area. On multivariable regression adjusted for age, sex, and race, CEF was associated with waist circumference, hip circumference, subcutaneous fat, and liver fat fraction.
Conclusion:
Waist and hip circumference and subcutaneous fat area are associated with impaired CEF, an established metric of abnormal vascular health in PLWH on stable ART, and may contribute to the increased rate of heart disease in this population.
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