Coronary Plaque in People With HIV vs Non-HIV Asymptomatic Community and Symptomatic Higher-Risk Populations

Julia Karady, Michael T. Lu, Göran Bergström, Thomas Mayrhofer, Jana Taron, Borek Foldyna, Kayla Paradis, Sara McCallum, Judith A. Aberg, Judith S. Currier, Kathleen V. Fitch, Evelynne S. Fulda, Gerald S. Bloomfield, Edgar T. Overton, Lars Lind, Carl Johan Östgren, Olof Elvstam, Stefan Söderberg, Tomas Jernberg, Rosalie PepeMichael P. Dubé, David Mushatt, Carl J. Fichtenbaum, Carlos Malvestutto, Markella V. Zanni, Udo Hoffmann, Heather Ribaudo, Steven K. Grinspoon, Pamela S. Douglas

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Abstract

Background: People with HIV (PWH) have a high burden of coronary plaques; however, the comparison to people without known HIV (PwoH) needs clarification. Objectives: The purpose of this study was to determine coronary plaque burden/phenotype in PWH vs PwoH. Methods: Nonstatin using participants from 3 contemporary populations without known coronary plaques with coronary CT were compared: the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) studying PWH without cardiovascular symptoms at low-to-moderate risk (n = 755); the SCAPIS (Swedish Cardiopulmonary Bioimage Study) of asymptomatic community PwoH at low-to-intermediate cardiovascular risk (n = 23,558); and the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) of stable chest pain PwoH (n = 2,291). The coronary plaque prevalence on coronary CT was compared, and comparisons were stratified by 10-year atherosclerotic cardiovascular disease (ASCVD) risk, age, and coronary artery calcium (CAC) presence. Results: Compared to SCAPIS and PROMISE PwoH, REPRIEVE PWH were younger (50.8 ± 5.8 vs 57.3 ± 4.3 and 60.0 ± 8.0 years; P < 0.001) and had lower ASCVD risk (5.0% ± 3.2% vs 6.0% ± 5.3% and 13.5% ± 11.0%; P < 0.001). More PWH had plaque compared to the asymptomatic cohort (48.5% vs 40.3%; P < 0.001). When stratified by ASCVD risk, PWH had more plaque compared to SCAPIS and a similar prevalence of plaque compared to PROMISE. CAC = 0 was more prevalent in PWH (REPRIEVE 65.2%; SCAPIS 61.6%; PROMISE 49.6%); among CAC = 0, plaque was more prevalent in PWH compared to the PwoH cohorts (REPRIEVE 20.8%; SCAPIS 5.4%; PROMISE 12.3%, P < 0.001). Conclusions: Asymptomatic PWH in REPRIEVE had more plaque than asymptomatic PwoH in SCAPIS but had similar prevalence to a higher-risk stable chest pain cohort in PROMISE. In PWH, CAC = 0 does not reliably exclude plaque.

Original languageEnglish
Article number100968
JournalJACC: Advances
Volume3
Issue number6
DOIs
StatePublished - Jun 2024

Keywords

  • asymptomatic community cohort
  • cardiovascular disease
  • coronary CT angiography
  • coronary plaque
  • people with HIV
  • stable chest pain

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