Carotid Plaque, Vascular Disease Event Risk Increase With HIV
Carotid plaque was associated with nearly a 3-fold increased risk for ASCVD and 4-fold increased risk for stroke.
People living with HIV (PLWHIV) are at increased risk for adverse cardiovascular events because of increased numbers of carotid plaque, noncalcified plaque, and high-risk plaque, according to a study published in Circulation: Cardiovascular Imaging.
PLWHIV have an increased risk for vascular events; however, whether this is the result of increased levels of incidental carotid plaque is unknown. To investigate, researchers used a retrospective study comparing PLWHIV and uninfected controls, drawing participants from an existing and validated research registry.
In total, 209 PLWHIV and 168 controls, free of known cardiovascular disease and who had received some type of computerized tomography scan that allowed assessment of plaque level were identified. Primary outcome was an atherosclerotic cardiovascular disease (ASCVD) event, defined as myocardial infarction, coronary heart disease death, or ischemic stroke. Secondary outcome was ischemic stroke.
There were no significant differences in age (45±10 vs 43±17 years; P =.07), sex (72% vs 65% male; P =.18), or other vascular risk factors such as prevalence of diabetes mellitus (10% vs 11%; P =.61), hyperlipidemia (15% vs17%; P =.67), and cigarette smoking (33% vs 30%; P =.57) between the two groups.
Three measures of plaque were increased in the PLWHIV group: carotid plaque (34% vs 25%; P =.04), noncalcified carotid plaque (18% vs 5%; P <.001), and any high-risk plaque (25% vs 16%; P =.03).
Results of a 3-year follow up showed that increased presence of plaque was associated with risk for ASCVD events and ischemic stroke in PLWHIV. There were 17 ASCVD events (9 ischemic strokes, 6 myocardial infarctions, and 2 coronary heart disease deaths).
In a multivariate analysis confined to PLWHIV, after adjustment for cardiovascular risk factors, carotid plaque, noncalcified carotid plaque, and high-risk plaque remained associated with an increased risk for ASCVD events and stroke.
The researchers concluded that, “further research is needed to identify the underlying mechanisms” of this risk and determine whether “interventions, such as statins, can reduce risk in this vulnerable population.”
Dr Grinspoon is a consultant for Gilead, Bristol-Myers Squibb, and Navidea and Theratechnologies.
Janjua SA Staziaki PV, Szilveszter B, et al. Presence, characteristics, and prognostic associations of carotid plaque among people living with HIV. Circ Cardiovasc Imaging. 2017;10(10):e005777.