Coronary artery calcium and all-cause mortality in the Multicenter AIDS Cohort Study

Abstract

Background and aims: People with HIV (PWH) have greater risk of subclinical cardiovascular disease than people without HIV, but few studies have evaluated risk for mortality based on coronary artery calcium (CAC) among PWH. We aimed to determine the association between CAC and all-cause mortality among men with (MWH) and without HIV (MWOH) and if it differs by HIV serostatus.

Methods: We performed a longitudinal analysis in the Multicenter AIDS Cohort Study. We included men who underwent non-contrast cardiac computed tomography. Cox regression analyses were used to examine the associations between CAC presence (Agatston score>0), and with extent of CAC (log (CAC+1)), and subsequent mortality to calculate adjusted hazard ratios [aHR]. We evaluated differences by HIV serostatus using multiplicative CAC × HIV interaction terms.

Results: Among 1344 men (mean age 50 years, CAC prevalence 45.7 %, 821 [61.1 %] MWH), we observed 108 deaths (13.2 %) among MWH and 43 deaths (8.2 %) among MWOH during follow-up (median:13.4 years). CAC presence was positively associated with mortality among all participants (aHR:1.46, 95 %CI:1.02-2.10, p = 0.04) and MWH (aHR:1.62, 1.05-2.49, p = 0.03). Among MWOH, we found no significant association (aHR:1.28, 0.63-2.58, p = 0.50). The extent of CAC was associated with mortality among all participants (aHR:1.37 per SD, 1.15-1.63, p < 0.001) and MWH (aHR:1.41,1.14-1.74, p = 0.002). Among MWOH, we found no significant association (aHR:1.35, 0.98-1.85, p = 0.07). There were no significant interactions by HIV serostatus for mortality for either the presence (p = 0.35) or extent of CAC (p = 0.51).

Conclusions: CAC was positively associated with mortality in a large cohort of MWH, and the overall cohort including MWH and MWOH.

Keywords: Coronary artery calcium; Human immunodeficiency virus; Mortality.