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Coronary artery calcium and all-cause mortality in the Multicenter AIDS Cohort Study
Takahiro Suzuki1, Sabina Haberlen2, Tess E Peterson3
1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan.
Insights
Coronary artery calcium (CAC) is linked to higher mortality in men with HIV (MWH). This association was observed in the overall cohort, including men with and without HIV, highlighting CAC as a significant risk factor.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- People with HIV (PWH) face elevated risks of subclinical cardiovascular disease.
- Limited research exists on the association between coronary artery calcium (CAC) and mortality specifically among PWH.
Purpose of the Study:
- To investigate the relationship between CAC and all-cause mortality in men with HIV (MWH) and men without HIV (MWOH).
- To determine if this association differs based on HIV serostatus.
Main Methods:
- Longitudinal analysis of data from the Multicenter AIDS Cohort Study.
- Inclusion of men who underwent non-contrast cardiac computed tomography.
- Cox regression analyses to assess associations between CAC presence/extent and mortality, evaluating differences by HIV serostatus using interaction terms.
Main Results:
- CAC presence was significantly associated with mortality in MWH (aHR: 1.62) and the overall cohort (aHR: 1.46).
- The extent of CAC also correlated with mortality in MWH (aHR: 1.41 per SD) and the overall cohort (aHR: 1.37 per SD).
- No significant association between CAC and mortality was found among MWOH, nor were there significant interactions by HIV serostatus.
Conclusions:
- Coronary artery calcium is positively associated with all-cause mortality in men with HIV.
- CAC presence and extent are linked to increased mortality risk in MWH and the combined cohort.
Background And Aims:
People with HIV (PWH) have greater risk of subclinical cardiovascular disease than people without HIV, but few studies have evaluated risk for mortality based on coronary artery calcium (CAC) among PWH. We aimed to determine the association between CAC and all-cause mortality among men with (MWH) and without HIV (MWOH) and if it differs by HIV serostatus.
Methods:
We performed a longitudinal analysis in the Multicenter AIDS Cohort Study. We included men who underwent non-contrast cardiac computed tomography. Cox regression analyses were used to examine the associations between CAC presence (Agatston score>0), and with extent of CAC (log (CAC+1)), and subsequent mortality to calculate adjusted hazard ratios [aHR]. We evaluated differences by HIV serostatus using multiplicative CAC × HIV interaction terms.
Results:
Among 1344 men (mean age 50 years, CAC prevalence 45.7 %, 821 [61.1 %] MWH), we observed 108 deaths (13.2 %) among MWH and 43 deaths (8.2 %) among MWOH during follow-up (median:13.4 years). CAC presence was positively associated with mortality among all participants (aHR:1.46, 95 %CI:1.02-2.10, p = 0.04) and MWH (aHR:1.62, 1.05-2.49, p = 0.03). Among MWOH, we found no significant association (aHR:1.28, 0.63-2.58, p = 0.50). The extent of CAC was associated with mortality among all participants (aHR:1.37 per SD, 1.15-1.63, p < 0.001) and MWH (aHR:1.41,1.14-1.74, p = 0.002). Among MWOH, we found no significant association (aHR:1.35, 0.98-1.85, p = 0.07). There were no significant interactions by HIV serostatus for mortality for either the presence (p = 0.35) or extent of CAC (p = 0.51).
Conclusions:
CAC was positively associated with mortality in a large cohort of MWH, and the overall cohort including MWH and MWOH.
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