Cardiovascular Project 3

摘要：项目3：艾滋病毒携带者的心血管风险 尽管艾滋病毒中心血管疾病(CVD)风险的增加部分归因于 心血管疾病的传统危险因素及对抗逆转录病毒治疗的介导作用，持续性炎症和免疫 监管失调也可能起到一定作用。女性对心血管疾病风险因素的负担更大，包括炎症， 尽管阻塞性冠状动脉疾病(CAD)较少，但临床仍在恶化 结果。在艾滋病毒妇女中，雌激素缺乏和过早发生心血管疾病的风险进一步增加。 更年期。 冠状动脉计算机断层血管成像(CCTA)不仅可以检测斑块的存在和体积， 但评估高危斑块(HRP)的特征。血管功能和结构措施包括 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 未来的心肌梗塞和中风。在HIV受试者中，CIMT更厚，颈动脉斑块的发生率是 控制。颈动脉的磁共振成像(MRI)提供了最先进的、准确的和 颈动脉壁厚度、斑块及其高危特征的可重复性测量，并允许 疾病进展的可靠衡量标准。 循环中的骨髓祖细胞(PC)积极参与心血管内环境的稳定 并调节心血管修复和再生。我们已经表明，数量的减少和 PC的迁移活动具有较高的心血管疾病风险和死亡率。此外，女性的血液循环次数较少。 PC与男性的比较，PC的水平与雌激素状态相关。在HIV受试者中，PC计数较低 提供了再生能力降低的证据。 我们在这个项目中的总体目标是确定艾滋病毒感染对妇女和女性造成的伤害 环境因素(炎症、艾滋病毒状况)和内源性修复/再生过程 雌激素缺乏及其联合作用对亚临床冠状动脉粥样硬化性心脏病发生和发展的影响 颈动脉CCTA和MRI检测颈动脉粥样硬化程度。 在目标1中，我们将研究艾滋病毒相关变化对再生能力、内皮功能和 常见的冠状动脉和颈动脉疾病的动脉僵硬。在目标2中，我们建议评估这些因素 这是颈动脉疾病进展的基础，使用连续两年的磁共振成像进行测量。在……里面 目的3、比较动脉粥样硬化斑块总体积及其高危特征， 在感染和未感染艾滋病毒的妇女中使用CCTA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.