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Subclinical coronary artery disease in Swiss HIV-positive and HIV-negative persons

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Tarr Philip E, Ledergerber Bruno, Calmy Alexandra, Doco-Lecompte Thanh, Marzel Alex, Weber Rainer, Kaufmann Philipp A, Nkoulou René, Buechel Ronny R, Kovari Helen,
Project Dynamics of atherosclerosis progression in HIV-infected and HIV-uninfected persons - a longitudinal study using coronary computed tomography angiography
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Original article (peer-reviewed)

Journal European Heart Journal
Volume (Issue) 39(23)
Page(s) 2147 - 2154
Title of proceedings European Heart Journal
DOI 10.1093/eurheartj/ehy163

Abstract

Abstract AIMS: HIV-positive persons have increased cardiovascular event rates but data on the prevalence of subclinical atherosclerosis compared with HIV-negative persons are not uniform. We assessed subclinical atherosclerosis utilizing coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA) in 428 HIV-positive participants of the Swiss HIV Cohort Study and 276 HIV-negative controls concurrently referred for clinically indicated CCTA. METHODS AND RESULTS: We assessed the association of HIV infection, cardiovascular risk profile, and HIV-related factors with subclinical atherosclerosis in univariable and multivariable analyses. HIV-positive participants (median duration of HIV infection, 15 years) were younger than HIV-negative participants (median age 52 vs. 56 years; P < 0.01) but had similar median 10-year Framingham risk scores (9.0% vs. 9.7%; P = 0.40). The prevalence of CAC score >0 (53% vs. 56.2%; P = 0.42) and median CAC scores (47 vs. 47; P = 0.80) were similar, as was the prevalence of any, non-calcified/mixed, and high-risk plaque. In multivariable adjusted analysis, HIV-positive participants had a lower prevalence of calcified plaque than HIV-negative participants [36.9% vs. 48.6%, P < 0.01; adjusted odds ratio (aOR) 0.57; 95% confidence interval (CI) 0.40-0.82; P < 0.01], lower coronary segment severity score (aOR 0.72; 95% CI 0.53-0.99; P = 0.04), and lower segment involvement score (aOR 0.71, 95% CI 0.52-0.97; P = 0.03). Advanced immunosuppression was associated with non-calcified/mixed plaque (aOR 1.97; 95% CI 1.09-3.56; P = 0.02). CONCLUSION: HIV-positive persons in Switzerland had a similar degree of non-calcified/mixed plaque and high-risk plaque, and may have less calcified coronary plaque, and lower coronary atherosclerosis involvement and severity scores than HIV-negative persons with similar Framingham risk scores. Comment in HIV and cardiovascular disease: much ado about nothing? [Eur Heart J. 2018]
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