Coronary Microvascular Dysfunction Is Present Among Well-Treated Asymptomatic Persons With HIV and Similar to Those
Suman Srinivasa1, Allie R Walpert1, Daniel Huck2,3
1Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Insights
Coronary microvascular dysfunction (CMD) is present in people with HIV (PWH), even when asymptomatic and well-treated. Their coronary flow reserve is reduced compared to those without HIV, similar to individuals with diabetes, indicating HIV is a cardiovascular disease risk factor.
Area of Science:
- Cardiology
- Infectious Diseases
- Vascular Medicine
Background:
- Coronary microvascular dysfunction (CMD) is a potential cause of heart disease in people with HIV (PWH).
- Understanding CMD in PWH is crucial for cardiovascular disease (CVD) risk assessment.
Purpose of the Study:
- To compare coronary flow reserve corrected for heart rate-blood pressure product (CFR_COR) among PWH, persons without HIV (PWOH), and persons with diabetes (PWDM).
- To investigate the prevalence of subclinical CMD in PWH.
Main Methods:
- CFR_COR was measured in three groups: PWH (n=39), PWOH (n=69), and PWDM (n=63).
- Participants were matched for age, sex, and body mass index, with PWH having no history of CVD or diabetes.
Main Results:
- CFR_COR was significantly lower in PWH compared to PWOH (P=0.04) and in PWDM compared to PWOH (P=0.007).
- PWH had CFR_COR values comparable to PWDM (P=0.98).
- Subclinical CMD (CFR_COR < 2.0) was found in 31% of PWH, 14% of PWOH, and 27% of PWDM. Women with HIV had a higher prevalence of CMD (40%) than women without HIV (6%).
Conclusions:
- Subclinical CMD is prevalent in PWH, even with controlled HIV infection and no prior CVD.
- Well-treated HIV infection is a CVD-risk enhancing factor for CMD, similar to diabetes.
- Findings highlight the need for increased cardiovascular surveillance in PWH.
Background:
Coronary microvascular dysfunction (CMD) could be a potential underlying mechanism for myocardial disease in HIV.
Methods:
Comparisons of coronary flow reserve corrected for heart rate-blood pressure product (CFRCOR) were made among people with HIV (PWH) with no known history of cardiovascular disease (CVD) or diabetes mellitus, persons without HIV (PWOH), and persons with diabetes (PWDM) and no known history of CVD or HIV.
Results:
PWH (n = 39, 74% male, age 55 [7] years, body mass index [BMI] 32.3 (26.8-34.9) kg/m2, duration of antiretroviral therapy 13 [5] years, CD4+ count 754 [598-961] cells/μL) were similar to PWOH (n = 69, 74% male, age 55 [8] years, BMI 32.2[25.6-36.5] kg/m2) and PWDM (n = 63, 63% male, age 55 [8] years, BMI 31.5 [28.6-35.6] kg/m2). CFRCOR was different among groups: PWOH 2.76 (2.37-3.36), PWH 2.47 (1.92-2.93), and PWDM 2.31 (1.98-2.84); overall P = .003. CFRCOR was reduced comparing PWH to PWOH (P = .04) and PWDM to PWOH (P = .007) but did not differ when comparing PWH to PWDM (P = .98). A total 31% of PWH had CFRCOR < 2.0, a critical cutoff for CMD, compared to 14% of PWOH and 27% with PWDM. A total 40% of women with HIV had a CFRCOR < 2.0 compared to 6% of women without HIV (P = .02).
Conclusions:
Subclinical CMD is present among chronically infected and well-treated, asymptomatic PWH who are immunologically controlled. This study demonstrates CFR is reduced in PWH compared to PWOH and comparable to PWDM, further highlighting that well-treated HIV infection is a CVD-risk enhancing factor for CMD similar to diabetes. Clinical Trials Registration: NCT02740179.
