Assessment of Coronary Artery Disease With Computed Tomography Angiography and Inflammatory and Immune Activation Biomarkers Among Adults With HIV Eligible for Primary Cardiovascular Prevention

JAMA Network Open,  June 2021.

Myocardial infarction and other atherosclerotic cardiovascular disease (ASCVD) events occur 1.5 to 2 times more often among people living with HIV than in the general population, but the prevalence of ASCVD among people living with HIV is not well understood. In this analysis from the mechanistic sub-study of the REPRIEVE Trial, investigators performed cardiac CT scans to determine the prevalence and composition of coronary artery disease among 755 REPRIEVE participants. They then assessed the findings to determine associations with traditional risk factors and biomarkers of immune activation and vascular and systemic inflammation.

The median age of the participants in this cohort was 51 years. Sixteen percent were female, 35 percent were Black, and 97 percent  had a plasma HIV viral load <400cp/mL. Overall, 49 percent showed evidence of atherosclerotic plaque in imaging, with significant plaque found even among participants who had the lowest ASCVD risk scores. Coronary artery plaque was more commonly detected among people who were older, male, White, had a family history of premature CVD, had hypertension, had elevated fasting glucose, and had higher LDL cholesterol levels. Markers of immune activation and vascular inflammation were also higher in people with detectable plaque. These data confirm that people living with HIV, including those with well-controlled viremia, have a significant coronary artery plaque burden and that inflammation and immune activation are important drivers of this excess cardiovascular disease risk. REPRIEVE will determine whether pitavastatin can prevent cardiovascular events in this at-risk population and whether the effect seen in this analysis is mediated through statins’ cholesterol lowering or anti-inflammatory effects.

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