Cardiovascular Project 3

摘要：项目 3：感染艾滋病毒的女性的心血管风险 尽管艾滋病毒导致的心血管疾病（CVD）风险增加部分归因于增加的负担 CVD传统危险因素以及抗逆转录病毒治疗介导的影响、持续炎症和免疫 失调也可能发挥作用。女性承受着更大的心血管疾病危险因素负担，包括炎症、 尽管阻塞性冠状动脉疾病（CAD）较少，但临床症状仍在恶化 结果。在艾滋病毒女性中，雌激素缺乏和早期感染进一步加剧了 CVD 风险。 更年期。 冠状动脉计算机断层扫描血管造影（CCTA）不仅可以检测斑块的存在和体积， 但评估高风险斑块 (HRP) 特征。血管功能和结构测量包括 颈动脉内膜中层厚度 (CIMT)、颈动脉斑块和肱动脉内皮功能可预测 未来的心肌梗死和中风。在 HIV 受试者中，CIMT 更厚，颈动脉斑块的发生率是 HIV 受试者的 1.5 倍 控制。颈动脉磁共振成像 (MRI) 提供最先进、准确且 可重复测量颈动脉壁厚度、斑块及其高风险特征，并允许 疾病进展的可靠衡量标准。 循环骨髓源性祖细胞 (PC) 积极参与心血管稳态 并介导心血管修复和再生。我们已经证明，数量和数量的减少 PC 的迁移活动会增加 CVD 风险和死亡率。此外，女性的循环数量较少 PC 与男性相比，PC 水平与雌激素状态相关。在 HIV 受试者中，PC 计数较低 提供再生能力降低的证据。 我们在该项目中的总体目标是确定女性艾滋病毒感染对造成伤害的因素的影响。 因素（炎症、艾滋病毒状况）和内源性修复/再生过程 雌激素缺乏及其对亚临床冠心病的存在和进展的综合影响 使用 CCTA 和颈动脉 MRI 测量颈动脉粥样硬化。 在目标 1 中，我们将研究 HIV 相关变化对再生能力、内皮功能和 动脉硬化对流行的冠状动脉和颈动脉疾病的影响。在目标 2 中，我们建议评估以下因素 这是颈动脉疾病进展的基础，通过两年的连续 MRI 测量得出。在 目标3，我们将比较总动脉粥样硬化斑块体积的程度及其高风险特征， 使用 CCTA 对感染和未感染 HIV 的女性进行测量。

ABSTRACT: PROJECT 3: CARDIOVASCULAR RISK IN WOMEN WITH HIV Although heightened cardiovascular disease (CVD) risk in HIV is partly attributable to an increased burden of CVD traditional risk factors and to antiretroviral therapy-mediated effects, persistent inflammation and immune dysregulation may also play a role. Women have a greater burden of CVD risk factors, including inflammation, despite having less obstructive coronary artery disease (CAD), but nevertheless have worsening clinical outcomes. Among HIV+ women, CVD risk is further compounded by estrogen deficiency and early menopause. Coronary computed tomographic angiography (CCTA) can not only detect the presence and volume of plaque, but assess high risk plaque (HRP) characteristics. Vascular functional and structural measures including carotid intima-media thickness (CIMT), carotid plaque, and brachial artery endothelial function are predictive of future MI and stroke. In HIV+ subjects, CIMT is thicker and carotid plaque 1.5-fold more prevalent compared to controls. Magnetic resonance imaging (MRI) of the carotid arteries provides a state-of-the-art, accurate and reproducible measure of carotid arterial wall thickness, plaque and its high risk characteristics, and permits reliable measures of disease progression. Circulating bone marrow-derived progenitor cells (PCs) are actively involved in cardiovascular homeostasis and mediate cardiovascular repair and regeneration. We have shown that a reduction in the number and migratory activity of PCs is higher CVD risk and mortality. Moreover, women have lower numbers of circulating PCs compared to men, and levels of PCs correlate with estrogen status. In HIV+ subjects, PC counts are lower providing evidence for reduced regenerative capacity. Our overall objective in this Project is to define the contribution of HIV infection in women to both injurious factors (inflammation, HIV status) and to endogenous reparative/regenerative processes in the setting of estrogen deficiency and their combined impact on the presence and progression of sub-clinical coronary and carotid artery atherosclerosis measured using CCTA and carotid MRI. In Aim 1, we will study the impact of HIV-related changes in regenerative capacity, endothelial function and arterial stiffness on prevalent coronary and carotid arterial disease. In Aim 2, we propose to assess the factors that underlie the progression of carotid arterial disease, measured using serial MRI over a 2-year period. In Aim 3, we will compare the extent of total atherosclerotic plaque volume and its' high risk characteristics, measured using CCTA in women with and without HIV.