Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men

Lawrence A. Kingsley, Jennifer A Deal, Lisa Paula Jacobson, Matthew Budoff, Mallory Witt, Frank Palella, Bridget Calhoun, Wendy S Post

Research output: Contribution to journalArticle

Abstract

Objective: The aim of this article is to determine whether HIV-infected (HIV+) men have either higher incidence or more rapid progression of coronary artery calcium (CAC) compared with HIV-uninfected (HIV∗) controls. Design: Prospective observational study. Setting: Multicenter study in four US academic research centers: University of Pittsburgh, Johns Hopkins University, University of California Los Angeles, and Northwestern University. Participants: Eight hundred and twenty-five men (541 HIV+and 284 HIV∗) enrolled in the cardiovascular substudy of the Multicenter AIDS Cohort Study who underwent serial cardiac computed tomography (CT) imaging during a mean follow-up of 5 years (range, 2-8 years). Main outcome measures: Incidence and progression of CAC assessed by cardiac CT. Results: During follow-up, 21% of HIV+ men developed incident CAC compared with 16% of HIV∗ men. This association persisted after adjustment for traditional and HIVassociated risk factors: hazard ratio 1.64 (1.13-3.14). However, there was no association between HIV serostatus and CAC progression among men with CAC present at baseline. Current smoking and increased insulin resistance, both modifiable risk factors, were independently associated with increased incidence of CAC. No evidence supporting an elevated risk for either CAC progression or incidence was found for either dyslipidemia or long-term usage of antiretroviral therapy. Conclusion: In this large study of HIV+ and HIV∗ men who underwent serial cardiac CT scan imaging, HIV+ men were at significantly higher risk for development of CAC: hazard ratio 1.64 (1.13-3.14). In addition, two important and modifiable risk factors were identified for increased incidence of CAC. Taken together, these findings underscore the potential importance for smoking cessation and interventions to improve insulin resistance among HIV+ men.

Original languageEnglish (US)
Pages (from-to)2427-2434
Number of pages8
JournalAIDS
Volume29
Issue number18
DOIs
StatePublished - 2015

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Coronary Vessels
HIV
Calcium
Incidence
Tomography
Insulin Resistance
Los Angeles
Smoking Cessation
Dyslipidemias
Multicenter Studies
Observational Studies
Acquired Immunodeficiency Syndrome
Cohort Studies
Smoking
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • Antiretroviral therapy
  • Atherosclerosis
  • Coronary artery calcium
  • HIV

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men. / Kingsley, Lawrence A.; Deal, Jennifer A; Jacobson, Lisa Paula; Budoff, Matthew; Witt, Mallory; Palella, Frank; Calhoun, Bridget; Post, Wendy S.

In: AIDS, Vol. 29, No. 18, 2015, p. 2427-2434.

Research output: Contribution to journalArticle

Kingsley, Lawrence A. ; Deal, Jennifer A ; Jacobson, Lisa Paula ; Budoff, Matthew ; Witt, Mallory ; Palella, Frank ; Calhoun, Bridget ; Post, Wendy S. / Incidence and progression of coronary artery calcium in HIV-infected and HIV-uninfected men. In: AIDS. 2015 ; Vol. 29, No. 18. pp. 2427-2434.
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abstract = "Objective: The aim of this article is to determine whether HIV-infected (HIV+) men have either higher incidence or more rapid progression of coronary artery calcium (CAC) compared with HIV-uninfected (HIV∗) controls. Design: Prospective observational study. Setting: Multicenter study in four US academic research centers: University of Pittsburgh, Johns Hopkins University, University of California Los Angeles, and Northwestern University. Participants: Eight hundred and twenty-five men (541 HIV+and 284 HIV∗) enrolled in the cardiovascular substudy of the Multicenter AIDS Cohort Study who underwent serial cardiac computed tomography (CT) imaging during a mean follow-up of 5 years (range, 2-8 years). Main outcome measures: Incidence and progression of CAC assessed by cardiac CT. Results: During follow-up, 21{\%} of HIV+ men developed incident CAC compared with 16{\%} of HIV∗ men. This association persisted after adjustment for traditional and HIVassociated risk factors: hazard ratio 1.64 (1.13-3.14). However, there was no association between HIV serostatus and CAC progression among men with CAC present at baseline. Current smoking and increased insulin resistance, both modifiable risk factors, were independently associated with increased incidence of CAC. No evidence supporting an elevated risk for either CAC progression or incidence was found for either dyslipidemia or long-term usage of antiretroviral therapy. Conclusion: In this large study of HIV+ and HIV∗ men who underwent serial cardiac CT scan imaging, HIV+ men were at significantly higher risk for development of CAC: hazard ratio 1.64 (1.13-3.14). In addition, two important and modifiable risk factors were identified for increased incidence of CAC. Taken together, these findings underscore the potential importance for smoking cessation and interventions to improve insulin resistance among HIV+ men.",
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AU - Witt, Mallory

AU - Palella, Frank

AU - Calhoun, Bridget

AU - Post, Wendy S

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N2 - Objective: The aim of this article is to determine whether HIV-infected (HIV+) men have either higher incidence or more rapid progression of coronary artery calcium (CAC) compared with HIV-uninfected (HIV∗) controls. Design: Prospective observational study. Setting: Multicenter study in four US academic research centers: University of Pittsburgh, Johns Hopkins University, University of California Los Angeles, and Northwestern University. Participants: Eight hundred and twenty-five men (541 HIV+and 284 HIV∗) enrolled in the cardiovascular substudy of the Multicenter AIDS Cohort Study who underwent serial cardiac computed tomography (CT) imaging during a mean follow-up of 5 years (range, 2-8 years). Main outcome measures: Incidence and progression of CAC assessed by cardiac CT. Results: During follow-up, 21% of HIV+ men developed incident CAC compared with 16% of HIV∗ men. This association persisted after adjustment for traditional and HIVassociated risk factors: hazard ratio 1.64 (1.13-3.14). However, there was no association between HIV serostatus and CAC progression among men with CAC present at baseline. Current smoking and increased insulin resistance, both modifiable risk factors, were independently associated with increased incidence of CAC. No evidence supporting an elevated risk for either CAC progression or incidence was found for either dyslipidemia or long-term usage of antiretroviral therapy. Conclusion: In this large study of HIV+ and HIV∗ men who underwent serial cardiac CT scan imaging, HIV+ men were at significantly higher risk for development of CAC: hazard ratio 1.64 (1.13-3.14). In addition, two important and modifiable risk factors were identified for increased incidence of CAC. Taken together, these findings underscore the potential importance for smoking cessation and interventions to improve insulin resistance among HIV+ men.

AB - Objective: The aim of this article is to determine whether HIV-infected (HIV+) men have either higher incidence or more rapid progression of coronary artery calcium (CAC) compared with HIV-uninfected (HIV∗) controls. Design: Prospective observational study. Setting: Multicenter study in four US academic research centers: University of Pittsburgh, Johns Hopkins University, University of California Los Angeles, and Northwestern University. Participants: Eight hundred and twenty-five men (541 HIV+and 284 HIV∗) enrolled in the cardiovascular substudy of the Multicenter AIDS Cohort Study who underwent serial cardiac computed tomography (CT) imaging during a mean follow-up of 5 years (range, 2-8 years). Main outcome measures: Incidence and progression of CAC assessed by cardiac CT. Results: During follow-up, 21% of HIV+ men developed incident CAC compared with 16% of HIV∗ men. This association persisted after adjustment for traditional and HIVassociated risk factors: hazard ratio 1.64 (1.13-3.14). However, there was no association between HIV serostatus and CAC progression among men with CAC present at baseline. Current smoking and increased insulin resistance, both modifiable risk factors, were independently associated with increased incidence of CAC. No evidence supporting an elevated risk for either CAC progression or incidence was found for either dyslipidemia or long-term usage of antiretroviral therapy. Conclusion: In this large study of HIV+ and HIV∗ men who underwent serial cardiac CT scan imaging, HIV+ men were at significantly higher risk for development of CAC: hazard ratio 1.64 (1.13-3.14). In addition, two important and modifiable risk factors were identified for increased incidence of CAC. Taken together, these findings underscore the potential importance for smoking cessation and interventions to improve insulin resistance among HIV+ men.

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KW - HIV

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