Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men.
Increased prevalence of subclinical coronary atherosclerosis detected by coronary computed tomography angiography in HIV-infected men.
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DOI：
10.1097/qad.0b013e328333ea9e
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发表时间：
2010-01-16
期刊：
影响因子：
--
通讯作者：
Grinspoon SK
中科院分区：
文献类型：
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作者：
Lo J;Abbara S;Shturman L;Soni A;Wei J;Rocha-Filho JA;Nasir K;Grinspoon SK
hiv感染患者的亚临床冠状动脉粥样硬化程度尚不清楚。我们利用冠状动脉计算机断层血管造影研究亚临床动脉粥样硬化的程度以及传统和非传统危险因素与早期动脉粥样硬化疾病的关系。前瞻性招募78名HIV感染男性（年龄46.5±6.5岁，HIV持续时间13.5±6.1年，CD4 T淋巴细胞523±282,81%无法检测到病毒载量）和32名HIV阴性男性（年龄45.4±7.2岁），具有相似的人口统计学和冠状动脉疾病（CAD）危险因素，无CAD病史或症状。采用64层多排计算机断层冠状动脉造影来确定冠状动脉粥样硬化、冠状动脉狭窄的患病率和定量斑块负担。hiv感染男性的冠状动脉粥样硬化患病率高于非hiv感染男性（59比34%，P = 0.02），冠状动脉斑块体积更高[55.9 (0-207.7)；中位数（IQR） vs. 0 (0 - 80.5) μl；P = 0.02]，有斑块的冠状动脉段数较多[1（0 - 3）比0（0 - 1）段；尽管心肌梗死、冠心病家族史和吸烟状况的Framingham 10年风险相似，但Agatston钙评分大于0的患病率较高（46比25%，P = 0.04）。在hiv感染者中，Framingham评分、总胆固醇、低密度脂蛋白、CD4/CD8比值、单核细胞趋化蛋白1与斑块负担显著相关。HIV感染持续时间与斑块体积（P = 0.002）和斑块段（P = 0.0009）显著相关，在调整年龄、传统危险因素或抗逆转录病毒治疗持续时间后，这些关系仍然显著。在我们的研究人群中，总共有6.5%（95%置信区间2-15%）的人表现出阻塞性CAD（70%管腔狭窄）的血管造影证据，而对照组为0%。与未感染艾滋病毒的患者相比，年轻、无症状、长期感染艾滋病毒的男性冠状动脉粥样硬化的患病率和程度更高。传统和非传统的危险因素都有助于hiv感染患者的动脉粥样硬化疾病。
The degree of subclinical coronary atherosclerosis in HIV-infected patients is unknown. We investigated the degree of subclinical atherosclerosis and the relationship of traditional and nontraditional risk factors to early atherosclerotic disease using coronary computed tomography angiography. Seventy-eight HIV-infected men (age 46.5 ± 6.5 years and duration of HIV 13.5 ± 6.1 years, CD4 T lymphocytes 523 ± 282; 81% undetectable viral load), and 32 HIV-negative men (age 45.4 ± 7.2 years) with similar demographic and coronary artery disease (CAD) risk factors, without history or symptoms of CAD, were prospectively recruited. 64-slice multidetector row computed tomography coronary angiography was performed to determine prevalence of coronary atherosclerosis, coronary stenosis, and quantitative plaque burden. HIV-infected men demonstrated higher prevalence of coronary atherosclerosis than non-HIV-infected men (59 vs. 34%; P = 0.02), higher coronary plaque volume [55.9 (0–207.7); median (IQR) vs. 0 (0–80.5) μl; P = 0.02], greater number of coronary segments with plaque [1 (0–3) vs. 0 (0–1) segments; P = 0.03], and higher prevalence of Agatston calcium score more than 0 (46 vs. 25%, P = 0.04), despite similar Framingham 10-year risk for myocardial infarction, family history of CAD, and smoking status. Among HIV-infected patients, Framingham score, total cholesterol, low-density lipoprotein, CD4/CD8 ratio, and monocyte chemoattractant protein 1 were significantly associated with plaque burden. Duration of HIV infection was significantly associated with plaque volume (P = 0.002) and segments with plaque (P = 0.0009) and these relationships remained significant after adjustment for age, traditional risk factors, or duration of antiretroviral therapy. A total of 6.5% (95% confidence interval 2–15%) of our study population demonstrated angiographic evidence of obstructive CAD (>70% luminal narrowing) as compared with 0% in controls. Young, asymptomatic, HIV-infected men with long-standing HIV disease demonstrate an increased prevalence and degree of coronary atherosclerosis compared with non-HIV-infected patients. Both traditional and nontraditional risk factors contribute to atherosclerotic disease in HIV-infected patients.