Coronary Artery Calcification and Plaque Characteristics in People Living With HIV: A Systematic Review and Meta-Analysis

Abstract

Background Studies have reported that people living with HIV have higher burden of subclinical cardiovascular disease, but the data are not adequately synthesized. We performed meta-analyses of studies of coronary artery calcium and coronary plaque in people living with HIV. Methods and Results We performed systematic search in electronic databases, and data were abstracted in standardized forms. Study-specific estimates were pooled using meta-analysis. 43 reports representing 27 unique studies and involving 10 867 participants (6699 HIV positive, 4168 HIV negative, mean age 52 years, 86% men, 32% Black) were included. The HIV-positive participants were younger (mean age 49 versus 57 years) and had lower Framingham Risk Score (mean score 6 versus 18) compared with the HIV-negative participants. The pooled estimate of percentage with coronary artery calcium >0 was 45% (95% CI, 43%-47%) for HIV-positive participants, and 52% (50%-53%) for HIV-negative participants. This difference was no longer significant after adjusting for difference in Framingham Risk Score between the 2 groups. The odds ratio of coronary artery calcium progression for HIV-positive versus -negative participants was 1.64 (95% CI, 0.91-2.37). The pooled estimate for prevalence of noncalcified plaque was 49% (95% CI, 47%-52%) versus 20% (95% CI, 17%-23%) for HIV-positive versus HIV-negative participants, respectively. Odds ratio for noncalcified plaque for HIV-positive versus -negative participants was 1.23 (95% CI, 1.08-1.38). There was significant heterogeneity that was only partially explained by available study-level characteristics. Conclusions People living with HIV have higher prevalence of noncalcified coronary plaques and similar prevalence of coronary artery calcium, compared with HIV-negative individuals. Future studies on coronary artery calcium and plaque progression can further elucidate subclinical atherosclerosis in people living with HIV.

Keywords: calcium score; cardiovascular disease; coronary artery calcium; coronary plaque; human immunodeficiency virus; subclinical atherosclerosis.

Figure 1. Meta‐analysis of prevalence of coronary calcium >0 by HIV status*.

Black boxes represent the prevalence estimates and the horizontal bars about are for the 95% CIs. The blue diamond is for the pooled prevalence estimate and 95% CI. *Analyses restricted to studies that recruited both HIV+ cases and HIV− controls. CAC indicates coronary artery calcium; and ES, prevalence.

Figure 2. Meta‐analysis of prevalence of calcified and non‐calcified plaque prevalence by HIV status*.

Conventions as per Figure 1. *A, calcified plaque; B, non‐calcified plaque. Analyses restricted to studies that recruited both HIV‐positive cases and HIV‐negative controls.

Figure 3. Meta‐analysis of odds ratio of plaque presence (HIV‐positive vs HIV‐negative) by type of plaque.

RR indicates relative risk. Red diamonds represent the effect estimates (odds ratios) and the horizontal bars about are for the 95% CIs. The size of the black boxes is proportional to the inverse variance. The black diamond is for the pooled odds ratio estimate and 95% CI—the upper diamond represents random‐effects model estimate and the lower diamond represents fixed‐effect model estimate.

Figure 4. Meta‐regression of coronary calcium presence study estimates by various study‐level characteristics.

The circles represent prevalence estimates for each study and the vertical bars represent 95% CIs. The red bars represent estimates for HIV‐positive participants, and the green bar represents estimates for HIV‐negative participants. The orange and green transverse lines were fitted using analytical weights of each estimate for HIV‐positive and HIV‐negative participants, respectively. R2 represents the proportion of the between study variance that is explained by the X‐axis variable. CAC, coronary artery calcium.

Figure 5. Meta‐regression of plaque burden study estimates by various study‐level characteristics.

Conventions as per Figure 4.