Association of Cardiac Troponin T With Coronary Atherosclerosis in Asymptomatic Primary Prevention People With HIV
Christopher deFilippi1, Sara McCallum2, Markella V Zanni2
1Inova Heart and Vascular Institute, Falls Church, Virginia, USA.
Insights
High-sensitivity cardiac troponin T (hs-cTnT) levels are linked to coronary plaque in people with HIV (PWH). Elevated hs-cTnT improves the identification of plaque features beyond traditional risk factors.
Area of Science:
- Cardiology
- Infectious Diseases
- Biomarkers
Background:
- Coronary plaque is prevalent in people with HIV (PWH) even with low-to-moderate traditional atherosclerotic cardiovascular disease (ASCVD) risk.
- Understanding subclinical atherosclerosis in PWH is crucial for cardiovascular risk management.
Purpose of the Study:
- To investigate the association between high-sensitivity cardiac troponin T (hs-cTnT) levels and coronary plaque characteristics in PWH.
- To determine if hs-cTnT improves the identification of coronary plaque features compared to traditional ASCVD risk factors.
Main Methods:
- Coronary computed tomography angiography was used to assess plaque characteristics in PWH on stable antiretroviral therapy with low-to-moderate ASCVD risk.
- hs-cTnT levels were measured and correlated with the presence of any plaque, vulnerable plaque, coronary artery calcium (CAC) score, and Leaman score.
- Model discrimination was assessed to evaluate hs-cTnT's contribution to identifying plaque features.
Main Results:
- In 708 PWH, elevated hs-cTnT levels (highest vs. undetectable) were associated with increased relative risks for any plaque (1.37), vulnerable plaque (1.47), CAC>100 (2.58), and Leaman score >5 (2.13).
- A detectable hs-cTnT level (≥6 ng/L) was observed in 61% of participants.
- The addition of hs-cTnT modestly improved the discrimination of ASCVD risk scores for identifying critical plaque features.
Conclusions:
- hs-cTnT levels are significantly associated with subclinical coronary plaque in people with HIV.
- hs-cTnT improves the prediction of coronary plaque characteristics, offering additional value beyond traditional ASCVD risk factors in PWH.
Background:
Coronary plaque is common among people with HIV (PWH) with low-to-moderate traditional atherosclerotic cardiovascular disease (ASCVD) risk.
Objectives:
The purpose of this study was to determine the association of high-sensitivity cardiac troponin T (hs-cTnT) levels with coronary plaque characteristics and evaluate if hs-cTnT improves identification of these features beyond traditional ASCVD risk factors among PWH.
Methods:
Among PWH receiving stable antiretroviral therapy with low-to-moderate ASCVD risk and no known history of ASCVD, hs-cTnT levels and measures of plaque by coronary computed tomography angiography were assessed. Primary outcomes included the association of hs-cTnT level with the presence of any plaque, vulnerable plaque, coronary artery calcium (CAC) score, and Leaman score. Assessment of model discrimination of hs-cTnT for plaque characteristics was also performed.
Results:
The cohort included 708 U.S. participants with a mean age of 51 ± 6 years, 119 (17%) females, a median ASCVD risk score of 4.4% (Q1-Q3: 2.5%-6.6%), and a median hs-cTnT level of 6.7 ng/L (detectable level ≥6 ng/L in 61%). Any plaque was present in 341 (48%), vulnerable plaque in 155 (22%), CAC>100 in 68 (10%), and a Leaman score >5 in 105 (15%). After adjustment for ASCVD risk score, participants with hs-cTnT >9.6 ng/L (highest category) versus an undetectable level (<6 ng/L) had a greater relative risk for any plaque (1.37, 95% CI: 1.12-1.67), vulnerable plaque (1.47, 95% CI: 1.16-1.87), CAC>100 (2.58, 95% CI: 1.37-4.83), and Leaman score >5 (2.13, 95% CI: 1.32-3.46). The addition of hs-cTnT level modestly improved the discrimination of ASCVD risk score to identify critical plaque features.
Conclusions:
In PWH without known ASCVD, hs-cTnT levels were strongly associated with and improved prediction of subclinical coronary plaque. (Evaluating the Use of Pitavastatin to Reduce the Risk of Cardiovascular Disease in HIV-Infected Adults [REPRIEVE]; NCT02344290).
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