Frailty and subclinical coronary atherosclerosis: The Multicenter AIDS Cohort Study (MACS)

Sai Krishna C. Korada, Di Zhao, Martin Tibuakuu, Todd T Brown, Lisa Paula Jacobson, Eliseo Guallar, Robert K. Bolan, Frank J. Palella, Joseph Bernard Margolick, Jeremy J. Martinson, Matthew J. Budoff, Wendy S Post, Erin Donnelly Michos

Research output: Contribution to journalArticle

Abstract

Background and aims: Frailty and cardiovascular disease share many risk factors. We evaluated whether frailty is independently associated with subclinical coronary atherosclerosis and whether any relationships differ by HIV-serostatus. Methods: We studied 976 [62% HIV-infected] male participants of the Multicenter AIDS Cohort Study who underwent assessment of frailty and non-contrast cardiac CT scanning; of these, 747 men also underwent coronary CT angiography (CCTA). Frailty was defined as having ≥3 of 5 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Coronary artery calcium (CAC) was assessed by non-contrast CT, and total plaque score (TPS), mixed plaque score (MPS), and non-calcified plaque score (NCPS) by CCTA. Multivariable-adjusted regression was used to assess the cross-sectional associations between frailty and subclinical coronary atherosclerosis. Results: Mean (SD) age of participants was 54 (7) years; 31% were black. Frailty existed in 7.5% and 14.3% of HIV-uninfected and HIV-infected men, respectively. After adjustment for demographics, frailty was significantly associated with prevalence of any CAC (CAC>0), any plaque (TPS>0), and mixed plaque (MPS>0) in HIV-uninfected but not in HIV-infected men (p-interactionHIV<0.05 for all). Among HIV-uninfected men, after adjustment for cardiovascular risk factors, frailty was significantly associated only with CAC>0 [Prevalence Ratio 1.27 (95%CI 1.02, 1.59)] and TPS>0 [1.19 (1.06, 1.35)]. No association was found for NCPS. Conclusions: Frailty was independently associated with subclinical coronary atherosclerosis among HIV-uninfected men, but not among HIV-infected men. Further work is needed to ascertain mechanisms underlying these differences and whether interventions that improve frailty (i.e. strength training) can improve cardiovascular outcomes.

Original languageEnglish (US)
JournalAtherosclerosis
DOIs
StateAccepted/In press - 2017

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Coronary Artery Disease
Acquired Immunodeficiency Syndrome
Cohort Studies
HIV
Coronary Vessels
Calcium
Coronary Angiography
Resistance Training
Weight Loss
Cardiovascular Diseases
Demography
Exercise

Keywords

  • Cardiac CT
  • Coronary artery calcium
  • Coronary atherosclerosis
  • Frailty
  • HIV-Infection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Frailty and subclinical coronary atherosclerosis : The Multicenter AIDS Cohort Study (MACS). / Korada, Sai Krishna C.; Zhao, Di; Tibuakuu, Martin; Brown, Todd T; Jacobson, Lisa Paula; Guallar, Eliseo; Bolan, Robert K.; Palella, Frank J.; Margolick, Joseph Bernard; Martinson, Jeremy J.; Budoff, Matthew J.; Post, Wendy S; Michos, Erin Donnelly.

In: Atherosclerosis, 2017.

Research output: Contribution to journalArticle

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title = "Frailty and subclinical coronary atherosclerosis: The Multicenter AIDS Cohort Study (MACS)",
abstract = "Background and aims: Frailty and cardiovascular disease share many risk factors. We evaluated whether frailty is independently associated with subclinical coronary atherosclerosis and whether any relationships differ by HIV-serostatus. Methods: We studied 976 [62{\%} HIV-infected] male participants of the Multicenter AIDS Cohort Study who underwent assessment of frailty and non-contrast cardiac CT scanning; of these, 747 men also underwent coronary CT angiography (CCTA). Frailty was defined as having ≥3 of 5 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Coronary artery calcium (CAC) was assessed by non-contrast CT, and total plaque score (TPS), mixed plaque score (MPS), and non-calcified plaque score (NCPS) by CCTA. Multivariable-adjusted regression was used to assess the cross-sectional associations between frailty and subclinical coronary atherosclerosis. Results: Mean (SD) age of participants was 54 (7) years; 31{\%} were black. Frailty existed in 7.5{\%} and 14.3{\%} of HIV-uninfected and HIV-infected men, respectively. After adjustment for demographics, frailty was significantly associated with prevalence of any CAC (CAC>0), any plaque (TPS>0), and mixed plaque (MPS>0) in HIV-uninfected but not in HIV-infected men (p-interactionHIV<0.05 for all). Among HIV-uninfected men, after adjustment for cardiovascular risk factors, frailty was significantly associated only with CAC>0 [Prevalence Ratio 1.27 (95{\%}CI 1.02, 1.59)] and TPS>0 [1.19 (1.06, 1.35)]. No association was found for NCPS. Conclusions: Frailty was independently associated with subclinical coronary atherosclerosis among HIV-uninfected men, but not among HIV-infected men. Further work is needed to ascertain mechanisms underlying these differences and whether interventions that improve frailty (i.e. strength training) can improve cardiovascular outcomes.",
keywords = "Cardiac CT, Coronary artery calcium, Coronary atherosclerosis, Frailty, HIV-Infection",
author = "Korada, {Sai Krishna C.} and Di Zhao and Martin Tibuakuu and Brown, {Todd T} and Jacobson, {Lisa Paula} and Eliseo Guallar and Bolan, {Robert K.} and Palella, {Frank J.} and Margolick, {Joseph Bernard} and Martinson, {Jeremy J.} and Budoff, {Matthew J.} and Post, {Wendy S} and Michos, {Erin Donnelly}",
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T1 - Frailty and subclinical coronary atherosclerosis

T2 - The Multicenter AIDS Cohort Study (MACS)

AU - Korada, Sai Krishna C.

AU - Zhao, Di

AU - Tibuakuu, Martin

AU - Brown, Todd T

AU - Jacobson, Lisa Paula

AU - Guallar, Eliseo

AU - Bolan, Robert K.

AU - Palella, Frank J.

AU - Margolick, Joseph Bernard

AU - Martinson, Jeremy J.

AU - Budoff, Matthew J.

AU - Post, Wendy S

AU - Michos, Erin Donnelly

PY - 2017

Y1 - 2017

N2 - Background and aims: Frailty and cardiovascular disease share many risk factors. We evaluated whether frailty is independently associated with subclinical coronary atherosclerosis and whether any relationships differ by HIV-serostatus. Methods: We studied 976 [62% HIV-infected] male participants of the Multicenter AIDS Cohort Study who underwent assessment of frailty and non-contrast cardiac CT scanning; of these, 747 men also underwent coronary CT angiography (CCTA). Frailty was defined as having ≥3 of 5 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Coronary artery calcium (CAC) was assessed by non-contrast CT, and total plaque score (TPS), mixed plaque score (MPS), and non-calcified plaque score (NCPS) by CCTA. Multivariable-adjusted regression was used to assess the cross-sectional associations between frailty and subclinical coronary atherosclerosis. Results: Mean (SD) age of participants was 54 (7) years; 31% were black. Frailty existed in 7.5% and 14.3% of HIV-uninfected and HIV-infected men, respectively. After adjustment for demographics, frailty was significantly associated with prevalence of any CAC (CAC>0), any plaque (TPS>0), and mixed plaque (MPS>0) in HIV-uninfected but not in HIV-infected men (p-interactionHIV<0.05 for all). Among HIV-uninfected men, after adjustment for cardiovascular risk factors, frailty was significantly associated only with CAC>0 [Prevalence Ratio 1.27 (95%CI 1.02, 1.59)] and TPS>0 [1.19 (1.06, 1.35)]. No association was found for NCPS. Conclusions: Frailty was independently associated with subclinical coronary atherosclerosis among HIV-uninfected men, but not among HIV-infected men. Further work is needed to ascertain mechanisms underlying these differences and whether interventions that improve frailty (i.e. strength training) can improve cardiovascular outcomes.

AB - Background and aims: Frailty and cardiovascular disease share many risk factors. We evaluated whether frailty is independently associated with subclinical coronary atherosclerosis and whether any relationships differ by HIV-serostatus. Methods: We studied 976 [62% HIV-infected] male participants of the Multicenter AIDS Cohort Study who underwent assessment of frailty and non-contrast cardiac CT scanning; of these, 747 men also underwent coronary CT angiography (CCTA). Frailty was defined as having ≥3 of 5 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Coronary artery calcium (CAC) was assessed by non-contrast CT, and total plaque score (TPS), mixed plaque score (MPS), and non-calcified plaque score (NCPS) by CCTA. Multivariable-adjusted regression was used to assess the cross-sectional associations between frailty and subclinical coronary atherosclerosis. Results: Mean (SD) age of participants was 54 (7) years; 31% were black. Frailty existed in 7.5% and 14.3% of HIV-uninfected and HIV-infected men, respectively. After adjustment for demographics, frailty was significantly associated with prevalence of any CAC (CAC>0), any plaque (TPS>0), and mixed plaque (MPS>0) in HIV-uninfected but not in HIV-infected men (p-interactionHIV<0.05 for all). Among HIV-uninfected men, after adjustment for cardiovascular risk factors, frailty was significantly associated only with CAC>0 [Prevalence Ratio 1.27 (95%CI 1.02, 1.59)] and TPS>0 [1.19 (1.06, 1.35)]. No association was found for NCPS. Conclusions: Frailty was independently associated with subclinical coronary atherosclerosis among HIV-uninfected men, but not among HIV-infected men. Further work is needed to ascertain mechanisms underlying these differences and whether interventions that improve frailty (i.e. strength training) can improve cardiovascular outcomes.

KW - Cardiac CT

KW - Coronary artery calcium

KW - Coronary atherosclerosis

KW - Frailty

KW - HIV-Infection

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