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.
Open Forum Infectious Diseases
|May 30, 2024
Summary
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.
