Coronary Plaque in People With HIV vs Non-HIV Asymptomatic Community and Symptomatic Higher-Risk Populations
Julia Karady1,2, Michael T Lu1, Göran Bergström3,4
1Cardiovascular Imaging Research Center, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, USA.
Insights
People with HIV (PWH) have higher coronary plaque burden than people without HIV (PwoH), even when asymptomatic. Coronary artery calcium (CAC) of zero does not reliably exclude plaque in PWH.
Area of Science:
- Cardiovascular Imaging
- HIV Research
- Public Health
Background:
- People with HIV (PWH) exhibit a significant burden of coronary plaques.
- Direct comparisons with people without known HIV (PwoH) require further clarification.
Purpose of the Study:
- To determine and compare coronary plaque burden and phenotype between PWH and PwoH.
- To investigate plaque prevalence across different cardiovascular risk strata.
Main Methods:
- Coronary CT scans from three cohorts were analyzed: REPRIEVE (PWH, n=755), SCAPIS (asymptomatic PwoH, n=23,558), and PROMISE (chest pain PwoH, n=2,291).
- Comparisons were stratified by 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and coronary artery calcium (CAC) presence.
- Participants were non-statin users without known coronary plaques.
Main Results:
- PWH in REPRIEVE were younger and had lower ASCVD risk than PwoH in SCAPIS and PROMISE.
- PWH showed a higher prevalence of coronary plaque compared to the asymptomatic PwoH cohort (48.5% vs 40.3%).
- PWH had more plaque than SCAPIS PwoH, and similar plaque prevalence to PROMISE PwoH, even with lower ASCVD risk.
- While PWH had more instances of CAC=0, plaque was more prevalent in PWH within this subgroup (20.8% vs 5.4% in SCAPIS and 12.3% in PROMISE).
Conclusions:
- Asymptomatic PWH have a greater plaque burden than asymptomatic PwoH.
- Coronary plaque prevalence in PWH is comparable to higher-risk PwoH cohorts, despite lower calculated ASCVD risk.
- Coronary artery calcium (CAC) score of zero does not reliably exclude the presence of coronary plaque in people with HIV.
Background:
People with HIV (PWH) have a high burden of coronary plaques; however, the comparison to people without known HIV (PwoH) needs clarification.
Objectives:
The purpose of this study was to determine coronary plaque burden/phenotype in PWH vs PwoH.
Methods:
Nonstatin using participants from 3 contemporary populations without known coronary plaques with coronary CT were compared: the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) studying PWH without cardiovascular symptoms at low-to-moderate risk (n = 755); the SCAPIS (Swedish Cardiopulmonary Bioimage Study) of asymptomatic community PwoH at low-to-intermediate cardiovascular risk (n = 23,558); and the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) of stable chest pain PwoH (n = 2,291). The coronary plaque prevalence on coronary CT was compared, and comparisons were stratified by 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and coronary artery calcium (CAC) presence.
Results:
Compared to SCAPIS and PROMISE PwoH, REPRIEVE PWH were younger (50.8 ± 5.8 vs 57.3 ± 4.3 and 60.0 ± 8.0 years; P < 0.001) and had lower ASCVD risk (5.0% ± 3.2% vs 6.0% ± 5.3% and 13.5% ± 11.0%; P < 0.001). More PWH had plaque compared to the asymptomatic cohort (48.5% vs 40.3%; P < 0.001). When stratified by ASCVD risk, PWH had more plaque compared to SCAPIS and a similar prevalence of plaque compared to PROMISE. CAC = 0 was more prevalent in PWH (REPRIEVE 65.2%; SCAPIS 61.6%; PROMISE 49.6%); among CAC = 0, plaque was more prevalent in PWH compared to the PwoH cohorts (REPRIEVE 20.8%; SCAPIS 5.4%; PROMISE 12.3%, P < 0.001).
Conclusions:
Asymptomatic PWH in REPRIEVE had more plaque than asymptomatic PwoH in SCAPIS but had similar prevalence to a higher-risk stable chest pain cohort in PROMISE. In PWH, CAC = 0 does not reliably exclude plaque.
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