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. 2013 May 15;27(8):1263-72.
doi: 10.1097/QAD.0b013e32835eca9b.

Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men

Markella V Zanni  1 , Suhny Abbara, Janet Lo, Bryan Wai, David Hark, Eleni Marmarelis, Steven K Grinspoon
Affiliations

Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men

Markella V Zanni et al. AIDS. .

Abstract

Objective: Among HIV-infected patients, high rates of myocardial infarction (MI) and sudden cardiac death have been observed. Exploring potential underlying mechanisms, we used multidetector spiral coronary computed tomography angiography (coronary CTA) to compare atherosclerotic plaque morphology in HIV-infected patients and non-HIV-infected controls.

Methods: Coronary atherosclerotic plaques visualized by CTA in HIV-infected (101) and non-HIV-infected (41) men without clinically apparent heart disease matched on cardiovascular risk factors were analyzed for three vulnerability features: low attenuation, positive remodeling, and spotty calcification.

Results: Ninety-five percent of HIV-infected patients were receiving ART (median duration 7.9 years) and had well controlled disease (median CD4 cell count, 473 cells/μl; median HIV RNA <50 copies/ml). Age and traditional cardiovascular risk factors were similar in HIV-infected patients and controls. Among the HIV-infected (versus control) group, there was a higher prevalence of patients with at least one: low attenuation plaque (22.8 versus 7.3%, P = 0.02), positively remodeled plaque (49.5 versus 31.7%, P = 0.05) and high-risk 3-feature plaque (7.9 versus 0%, P = 0.02). Moreover, patients in the HIV-infected (versus control) group demonstrated a higher number of low attenuation plaques (P = 0.01) and positively remodeled plaques (P = 0.03) per patient.

Conclusion: Our data demonstrate an increased prevalence of vulnerable plaque features among relatively young HIV-infected patients. Differences in coronary atherosclerotic plaque morphology - namely, increased vulnerable plaque among HIV-infected patients - are here for the first time reported and may contribute to increased rates of MI and sudden cardiac death in this population.

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Figures

Figure 1
Figure 1
Characteristic examples of plaques with vulnerability features including low attenuation (panel a), positive remodeling (panel b), and spotty calcification (panel c).
Figure 2
Figure 2
Prevalence of HIV-infected and non-HIV-infected subjects with at least one coronary atherosclerotic plaque positive for select vulnerability features.
See this image and copyright information in PMC

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