Epicardial adipose tissue and coronary artery calcium predict incident myocardial infarction and death in HIV-infected patients

J Cardiovasc Comput Tomogr. 2015 Nov-Dec;9(6):553-8. doi: 10.1016/j.jcct.2015.08.002. Epub 2015 Aug 15.

Abstract

Background: Epicardial adipose tissue (EAT) and coronary artery calcium (CAC) have been associated with incident coronary artery disease (CAD) and all-cause mortality in the general population. Their prognostic impact in HIV is unknown.

Methods: Observational study of 843 consecutive HIV-infected patients receiving antiretroviral therapy for at least 6 months. Risk stratification was performed with coronary artery calcium (CAC) scoring and EAT screening. Patients were followed for CAD and all-cause mortality for a median of 2.8 years accounting for a total of 2572 patient-year follow-up.

Results: Mean patient age was 50 ± 8 years and 69% were men. At baseline EAT was associated with male gender, age, waist circumference, visceral adipose tissue, and lipodystrophy, while CAC score ≥ 100 was associated with male gender, age and total cholesterol. During follow-up 33 patients suffered an event (15 incident myocardial infarctions and 18 deaths); the EAT volume was larger and the CAC score was higher in patients with events (p = 0.038 and p = 0.001 respectively). Multivariable regression analyses demonstrated that the upper tertile of EAT (≥ 93 cc; OR 2.15, 95% CI 1.06 - 4.39, p = 0.034), and CAC score ≥ 100 (OR 3.37, 95% CI 1.49 - 7.60, p = 0.003) were independent predictors of events after adjusting for age and sex.

Conclusions: In this observational cohort of HIV patients, EAT and CAC were independent predictors of hard outcomes after a median follow-up of approximately 3 years.

Keywords: Computed tomography; Coronary artery calcium; Epicardial adipose tissue; HIV infection.

Publication types

  • Observational Study

MeSH terms

  • Adipose Tissue / diagnostic imaging*
  • Adult
  • Anti-HIV Agents / therapeutic use
  • Coronary Angiography / methods*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / therapy
  • Coronary Vessels / diagnostic imaging*
  • Female
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy
  • HIV Infections / mortality*
  • Humans
  • Incidence
  • Italy / epidemiology
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / mortality*
  • Odds Ratio
  • Pericardium / diagnostic imaging*
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed*
  • Vascular Calcification / diagnostic imaging*
  • Vascular Calcification / mortality
  • Vascular Calcification / therapy

Substances

  • Anti-HIV Agents