Assessment of Coronary Artery Disease With Computed Tomography Angiography and Inflammatory and Immune Activation Biomarkers Among Adults With HIV Eligible for Primary Cardiovascular Prevention.
Assessment of Coronary Artery Disease With Computed Tomography Angiography and Inflammatory and Immune Activation Biomarkers Among Adults With HIV Eligible for Primary Cardiovascular Prevention.
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用计算机断层血管造影和炎症和免疫激活生物标志物评估成年HIV感染者冠状动脉疾病的初级心血管预防
DOI：
10.1001/jamanetworkopen.2021.14923
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发表时间：
2021-06-01
影响因子：
13.8
通讯作者：
REPRIEVE trial
中科院分区：
文献类型：
--
作者：
Hoffmann U;Lu MT;Foldyna B;Zanni MV;Karady J;Taron J;Zhai BK;Burdo T;Fitch KV;Kileel EM;Williams K;Fichtenbaum CJ;Overton ET;Malvestutto C;Aberg J;Currier J;Sponseller CA;Melbourne K;Floris-Moore M;Van Dam C;Keefer MC;Koletar SL;Douglas PS;Ribaudo H;Mayrhofer T;Grinspoon SK;REPRIEVE trial
在HIV控制良好和动脉粥样硬化性心血管疾病（ASCVD）低至中度风险的人群中，冠状动脉疾病的程度如何？冠状动脉疾病与传统风险、炎症和免疫激活指数之间的关系如何？在这项对755名HIV感染者的队列研究中，冠状动脉斑块非常普遍。严重狭窄是罕见的，但高危斑块特征，包括易损斑块和高Leaman评分，在大约五分之一的参与者中观察到;斑块指数与ASCVD风险评分相关，并且独立地与炎症和免疫激活指数相关。这些研究结果表明，低至中度心血管疾病风险的HIV感染者具有与炎症和免疫激活标志物相关的冠状动脉斑块的显著患病率。这项队列研究使用计算机断层扫描血管造影术以及炎症和免疫激活生物标志物评估，检查了控制良好的HIV和低至中度动脉粥样硬化性心血管疾病风险的成人中冠状动脉疾病（CAD）的患病率。心血管疾病（CVD）在HIV感染者（PWH）中增加，但对于具有低至中度传统CVD风险的PWH中冠状动脉疾病（CAD）的患病率和程度以及相关生物学因素知之甚少。确定PWH中与CVD相关的独特因素，并通过冠状动脉计算机断层扫描血管造影（CTA）和动脉炎症和免疫激活的关键途径评估CAD。这项在40至75岁的男性和女性PWH中进行的队列研究，没有已知的CVD，接受稳定的抗逆转录病毒治疗，根据2013年美国心脏病学院/美国心脏协会汇总队列方程，具有低至中度动脉粥样硬化性心血管疾病（ASCVD）风险，是预防HIV患者血管事件的随机试验的一部分。（REPRIEVE），这是一项在美国31个研究中心进行的在PWH中进行的他汀类药物治疗的大型一级预防试验。参与者于2015年5月至2018年2月入组。数据分析于2020年5月至12月进行。艾滋病。主要结局是通过冠状动脉CTA评估的CAD的患病率和组成，其次是CAD与传统风险指数和循环生物标志物的相关性，包括胰岛素、单核细胞趋化蛋白1（MCP-1）、白细胞介素（IL）6、可溶性CD 14（sCD 14）、sCD 163、脂蛋白相关磷脂酶A2（LpPLA 2）、氧化低密度脂蛋白（oxLDL）、和高敏C反应蛋白（hsCRP）。样本包括755名参与者，平均（SD）年龄为51（6）岁，124名（16%）女性参与者，267名（35%）黑人或非裔美国人参与者，182名（24%）拉丁裔参与者，中位（四分位数间距）ASCVD风险较低（4.5% [2.6%-6.8%]），病毒血症控制良好。总体而言，在368名参与者（49%）中观察到斑块，其中包括175名参与者中的52名（30%），动脉粥样硬化性CVD（ASCVD）风险低于2.5%。管腔阻塞至少50%是罕见的（25 [3%]），但易损斑块和高Leaman评分（即>5）更常见（分别为172/755 [23%]和118/743 [16%]）。总体而言，718名参与者中有251名（35%）显示冠状动脉钙化评分大于0。与无斑块的患者相比，有斑块的患者的IL-6、LpPLA 2、oxLDL和MCP-1水平更高（例如，IL-6水平中位数[IQR]为1.71 [1.05-3.04] pg/mL vs 1.45 [0.96-2.60] pg/mL; P = 0.008）。LpPLA 2和IL-6水平与校正模型中的斑块相关，独立于传统风险指数和HIV参数（例如，IL-6：校正比值比，1.07; 95%CI，1.02-1.12; P = .01）。在一项大型一级预防队列研究中，HIV控制良好，ASCVD风险低至中度，CAD（包括非钙化、非阻塞性和易损斑块）非常普遍。斑块参与者表现出较高水平的免疫激活和动脉炎症，独立于传统的ASCVD风险和HIV参数。
What is the extent of coronary artery disease among people with well-controlled HIV and low to moderate risk of atherosclerotic cardiovascular disease (ASCVD), and how is coronary artery disease associated with traditional risk, inflammatory, and immune activation indices? In this cohort study of 755 people with HIV, coronary plaque was highly prevalent. Critical stenosis was rare, but higher-risk plaque features, including vulnerable plaque and high Leaman scores, were seen in approximately one-fifth of participants; plaque indices were associated with ASCVD risk scores and, independently, indices of inflammation and immune activation. These findings suggest that people with HIV at low to moderate risk of cardiovascular disease have a significant prevalence of coronary plaque associated with inflammation and immune activation markers. This cohort study examines the prevalence of coronary artery disease (CAD) among adults with well-controlled HIV and low to moderate risk of atherosclerotic cardiovascular disease using computed tomography angiography and assessment of inflammation and immune activation biomarkers. Cardiovascular disease (CVD) is increased among people with HIV (PWH), but little is known regarding the prevalence and extent of coronary artery disease (CAD) and associated biological factors in PWH with low to moderate traditional CVD risk. To determine unique factors associated with CVD in PWH and to assess CAD by coronary computed tomography angiography (CTA) and critical pathways of arterial inflammation and immune activation. This cohort study among male and female PWH, aged 40 to 75 years, without known CVD, receiving stable antiretroviral therapy, and with low to moderate atherosclerotic cardiovascular disease (ASCVD) risk according to the 2013 American College of Cardiology/American Heart Association pooled cohort equation, was part of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), a large, ongoing primary prevention trial of statin therapy among PWH conducted at 31 US sites. Participants were enrolled from May 2015 to February 2018. Data analysis was conducted from May to December 2020. HIV disease. The primary outcome was the prevalence and composition of CAD assessed by coronary CTA and, secondarily, the association of CAD with traditional risk indices and circulating biomarkers, including insulin, monocyte chemoattractant protein 1 (MCP-1), interleukin (IL) 6, soluble CD14 (sCD14), sCD163, lipoprotein-associated phospholipase A2 (LpPLA2), oxidized low-density lipoprotein (oxLDL), and high-sensitivity C-reactive protein (hsCRP). The sample included 755 participants, with a mean (SD) age of 51 (6) years, 124 (16%) female participants, 267 (35%) Black or African American participants, 182 (24%) Latinx participants, a low median (interquartile range) ASCVD risk (4.5% [2.6%-6.8%]), and well-controlled viremia. Overall, plaque was seen in 368 participants (49%), including among 52 of 175 participants (30%) with atherosclerotic CVD (ASCVD) risk of less than 2.5%. Luminal obstruction of at least 50% was rare (25 [3%]), but vulnerable plaque and high Leaman score (ie, >5) were more frequently observed (172 of 755 [23%] and 118 of 743 [16%], respectively). Overall, 251 of 718 participants (35%) demonstrated coronary artery calcium score scores greater than 0. IL-6, LpPLA2, oxLDL, and MCP-1 levels were higher in those with plaque compared with those without (eg, median [IQR] IL-6 level, 1.71 [1.05-3.04] pg/mL vs 1.45 [0.96-2.60] pg/mL; P = .008). LpPLA2 and IL-6 levels were associated with plaque in adjusted modeling, independent of traditional risk indices and HIV parameters (eg, IL-6: adjusted odds ratio, 1.07; 95% CI, 1.02-1.12; P = .01). In this study of a large primary prevention cohort of individuals with well-controlled HIV and low to moderate ASCVD risk, CAD, including noncalcified, nonobstructive, and vulnerable plaque, was highly prevalent. Participants with plaque demonstrated higher levels of immune activation and arterial inflammation, independent of traditional ASCVD risk and HIV parameters.
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影响因子：
39
作者：
Freiberg MS;Chang CC;Kuller LH;Skanderson M;Lowy E;Kraemer KL;Butt AA;Bidwell Goetz M;Leaf D;Oursler KA;Rimland D;Rodriguez Barradas M;Brown S;Gibert C;McGinnis K;Crothers K;Sico J;Crane H;Warner A;Gottlieb S;Gottdiener J;Tracy RP;Budoff M;Watson C;Armah KA;Doebler D;Bryant K;Justice AC
通讯作者：
Justice AC
影响因子：
11.8
作者：
Guaraldi, Giovanni;Orlando, Gabriella;Palella, Frank
通讯作者：
Palella, Frank
影响因子：
3.8
作者：
Thomas, Guajira P.;Li, Xiuhong;Palella, Frank J., Jr.
通讯作者：
Palella, Frank J., Jr.
影响因子：
4.8
作者：
Grinspoon, Steven K.;Fitch, Kathleen V.;Douglas, Pamela S.
通讯作者：
Douglas, Pamela S.
DOI：
10.1097/qad.0b013e328333ea9e
发表时间：
2010-01-16
期刊：
AIDS (London, England)
影响因子：
--
作者：
Lo J;Abbara S;Shturman L;Soni A;Wei J;Rocha-Filho JA;Nasir K;Grinspoon SK
通讯作者：
Grinspoon SK