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. 2019 May 7;8(9):e011037.
doi: 10.1161/JAHA.118.011037.

Carnitine Is Associated With Atherosclerotic Risk and Myocardial Infarction in HIV -Infected Adults

Arjun Sinha  1 , Yifei Ma  2 , Rebecca Scherzer  2 , Smruti Rahalkar  3 , Brendan D Neilan  3 , Heidi Crane  4 , Daniel Drozd  4 , Jeffrey Martin  5 , Steven G Deeks  6 , Peter Hunt  7 , Priscilla Y Hsue  3
Affiliations

Carnitine Is Associated With Atherosclerotic Risk and Myocardial Infarction in HIV -Infected Adults

Arjun Sinha et al. J Am Heart Assoc. .

Abstract

Background People living with HIV ( PLWH ) have an increased risk of myocardial infarction ( MI ). Changes in the gut microbiota that occur with chronic HIV infection could play a role in HIV -associated atherosclerosis. Choline, carnitine, betaine, and trimethylamine N-oxide are small molecules that are, in part, metabolized or produced by the gut microbiome. We hypothesized that these metabolites would be associated with carotid artery intima-media thickness and MI in PLWH . Methods and Results Carotid artery intima-media thickness was measured at baseline and at a median interval of 4 years in 162 PLWH from the SCOPE (Study of the Consequences of the Protease Inhibitor Era) cohort in San Francisco, CA . Separately, 105 PLWH (36 cases with type I adjudicated MI and 69 controls without MI ) were selected from the Center for AIDS Research Network of Integrated Clinical Systems, a multicenter clinic-based cohort. Controls were matched by demographics, CD 4 cell count, and duration of viral suppression. In the SCOPE cohort, higher carnitine levels had a significant association with presence of carotid plaque and greater baseline and progression of mean carotid artery intima-media thickness after adjusting for traditional cardiovascular disease risk factors. In the treated and suppressed subgroup, these associations with carnitine remained significant after adjustment for cardiovascular disease risk factors. In the Center for AIDS Research Network of Integrated Clinical Systems cohort, the risk of MI was significantly increased in subjects with carnitine levels in the highest quartile after adjustment for cardiovascular disease risk factors. Conclusions In PLWH , including the treated and suppressed subgroup, carnitine is independently associated with carotid artery intima-media thickness, carotid plaque, and MI in 2 separate cohorts. These results emphasize the potential role of gut microbiota in HIV -associated atherosclerosis and MI , especially in relation to carnitine metabolism.

Keywords: HIV; atherosclerosis; carnitine; gut microbiota; myocardial infarction.

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Figures

Figure 1
Figure 1
Association of highest quartile of each metabolite with odds of myocardial infarction (MI) in the Center for AIDS Research Network of Integrated Clinical Systems cohort. The odds ratio for MI was obtained from a conditional logistic regression model and shown with 95% CI. TMAO indicates trimethylamine N‐oxide.
See this image and copyright information in PMC

References

    1. Lang S, Mary‐Krause M, Cotte L, Gilquin J, Partisani M, Simon A, Boccara F, Bingham A, Costagliola D. Increased risk of myocardial infarction in HIV‐infected patients in France, relative to the general population. AIDS. 2010;24:1228–1230. - PubMed
    1. Smith CJ, Ryom L, Weber R, Morlat P, Pradier C, Reiss P, Kowalska JD, de Wit S, Law M, el Sadr W, Kirk O, Friis‐Moller N, Monforte A, Phillips AN, Sabin CA, Lundgren JD. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet. 2014;384:241–248. - PubMed
    1. Kearns A, Gordon J, Burdo TH, Qin X. HIV‐1‐associated atherosclerosis: unraveling the missing link. J Am Coll Cardiol. 2017;69:3084–3098. - PMC - PubMed
    1. Gili S, Grosso Marra W, D'Ascenzo F, Lonni E, Calcagno A, Cannillo M, Ballocca F, Cerrato E, Pianelli M, Barbero U, Mancone M, DiNicolantonio JJ, Lavie CJ, Omede P, Montefusco A, Bonora S, Gasparini M, Biondi‐Zoccai G, Moretti C, Gaita F. Comparative safety and efficacy of statins for primary prevention in human immunodeficiency virus‐positive patients: a systematic review and meta‐analysis. Eur Heart J. 2016;37:3600–3609. - PubMed
    1. Drozd DR, Kitahata MM, Althoff KN, Zhang J, Gange SJ, Napravnik S, Burkholder GA, Mathews WC, Silverberg MJ, Sterling TR, Heckbert SR, Budoff MJ, Van Rompaey S, Delaney JAC, Wong C, Tong W, Palella FJ, Elion RA, Martin JN, Brooks JT, Jacobson LP, Eron JJ, Justice AC, Freiberg MS, Klein DB, Post WS, Saag MS, Moore RD, Crane HM. Increased risk of myocardial infarction in HIV‐infected individuals in North America compared with the general population. J Acquir Immune Defic Syndr. 2017;75:568–576. - PMC - PubMed

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