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Bajdechi M, Gurghean A, Bataila V, Scafa-Udriște A, Bajdechi GE, Radoi R, Oprea AC, Chioncel V, Mateescu I, Zekra L, Cernat R, Dumitru IM, Rugina S. Particular Aspects Related to CD4+ Level in a Group of HIV-Infected Patients and Associated Acute Coronary Syndrome. Diagnostics (Basel) 2023; 13:2682. [PMID: 37627941 PMCID: PMC10453880 DOI: 10.3390/diagnostics13162682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
People living with HIV infection are at high risk for cardiovascular events due to inflammation and atherosclerosis. Also, some antiretroviral therapies may contribute to the risk of cardiovascular complications. Immune status is highly dependent on the level of lymphocyte T helper CD4+. There are data suggesting that immune status and CD4+ cell count may be involved in the development of cardiovascular complications in these patients. Our study is longitudinal and retrospective and included a total number of 50 patients with HIV infection associated with acute coronary syndrome, divided into two subgroups based on the nadir of CD4+ cells. This study analyzes the relationship between the immune status of HIV patients, assessed by the nadir of the CD4+ T-cell count, and the outcome of these patients. Also, secondary endpoints were the assessment of the magnitude of coronary lesions and of thrombotic and bleeding risk assessed by specific scores. Clinical and biological parameters and also the extension and complexity of coronary lesions were assessed. Although patients with poor immune status had more complex coronary lesions and increased operative risk and bleeding risk at one year, this was not associated with significant differences in major adverse cardiac and cerebrovascular events at the 30-day and 1-year outcomes.
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Affiliation(s)
- Mircea Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
| | - Adriana Gurghean
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Vlad Bataila
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Alexandru Scafa-Udriște
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Georgiana-Elena Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Roxana Radoi
- Clinical Hospital of Infectious and Tropical Disease “Dr. Victor Babes” of Bucharest, 030303 Bucharest, Romania;
| | - Anca Cristiana Oprea
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
- Clinical Hospital of Infectious and Tropical Disease “Dr. Victor Babes” of Bucharest, 030303 Bucharest, Romania;
| | - Valentin Chioncel
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Iuliana Mateescu
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” of Bucharest, 050474 Bucharest, Romania; (M.B.); (A.S.-U.); (G.-E.B.); (A.C.O.); (V.C.); (I.M.)
| | - Lucia Zekra
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Roxana Cernat
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Irina Magdalena Dumitru
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Sorin Rugina
- Doctoral School of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (L.Z.); (R.C.); (I.M.D.); (S.R.)
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
- Romanian Academy of Medical Sciences, 030167 Bucharest, Romania
- Academy of Romanian Scientists, 050045 Bucharest, Romania
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Bajdechi M, Gurghean A, Bataila V, Scafa-Udriste A, Radoi R, Oprea AC, Marinescu A, Ion S, Chioncel V, Nicula A, Anastasiou A, Bajdechi GE, Savulescu-Fiedler I, Dumitru IM, Rugina S. Cardiovascular Risk Factors, Angiographical Features and Short-Term Prognosis of Acute Coronary Syndrome in People Living with Human Immunodeficiency Virus: Results of a Retrospective Observational Multicentric Romanian Study. Diagnostics (Basel) 2023; 13:diagnostics13091526. [PMID: 37174918 PMCID: PMC10177561 DOI: 10.3390/diagnostics13091526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
People living with human immunodeficiency virus have increased cardiovascular risk due to a higher prevalence of traditional and particular risk factors such as chronic inflammation, immune dysregulation, endothelial dysfunction, coagulation abnormalities and antiretroviral therapy. In developed countries, coronary artery disease has become the most frequent cardiovascular disease and an important cause of mortality in these patients. The symptomatology of an acute coronary syndrome can be atypical, and the prevalence of each type of acute coronary syndrome is reported differently. Regarding coronary artery disease severity in people living with HIV, the literature data indicates that the presence of single-vessel disease is akin to that of HIV-negative patients, and their short-term prognosis is unclear. This study aims to assess the clinical characteristics, biological parameters, angiographical features and short-term prognosis of acute coronary syndrome in a cohort of Romanian people living with human immunodeficiency virus.
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Affiliation(s)
- Mircea Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
| | - Adriana Gurghean
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Vlad Bataila
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Alexandru Scafa-Udriste
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania
| | - Roxana Radoi
- Clinical Hospital of Infectious and Tropical Disease "Dr. Victor Babes" of Bucharest, 030303 Bucharest, Romania
| | - Anca Cristiana Oprea
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
- Clinical Hospital of Infectious and Tropical Disease "Dr. Victor Babes" of Bucharest, 030303 Bucharest, Romania
| | - Adrian Marinescu
- National Institute of Infectious Disease "Prof. Dr. Matei Bals" of Bucharest, 021105 Bucharest, Romania
| | - Stefan Ion
- Faculty of Medicine, "Titu Maiorescu" University of Bucharest, 040441 Bucharest, Romania
| | - Valentin Chioncel
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Alina Nicula
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Achilleas Anastasiou
- Departament of Statistics and Actuarial-Financial Mathematics, Laboratory of Statistics and Data Analysis, University of Aegean, 83200 Samos, Greece
| | - Georgiana-Elena Bajdechi
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Ilinca Savulescu-Fiedler
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila" of Bucharest, 050474 Bucharest, Romania
| | - Irina Magdalena Dumitru
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
| | - Sorin Rugina
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
- Clinical Infectious Disease Hospital of Constanta, 900178 Constanta, Romania
- Romanian Academy of Medical Sciences, 030167 Bucuresti, Romania
- Academy of Romanian Scientists, 030167 Bucuresti, Romania
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Ntsekhe M, Baker JV. Cardiovascular Disease Among Persons Living With HIV: New Insights Into Pathogenesis and Clinical Manifestations in a Global Context. Circulation 2023; 147:83-100. [PMID: 36576956 DOI: 10.1161/circulationaha.122.057443] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Widespread use of contemporary antiretroviral therapy globally has transformed HIV disease into a chronic illness associated with excess risk for disorders of the heart and circulatory system. Current clinical care and research has focused on improving HIV-related cardiovascular disease outcomes, survival, and quality of life. In high-income countries, emphasis on prevention of atherosclerotic coronary artery disease over the past decade, including aggressive management of traditional risk factors and earlier initiation of antiretroviral therapy, has reduced risk for myocardial infarction among persons living with human immunodeficiency virus-1 infection. Still, across the globe, persons living with human immunodeficiency virus-1 infection on effective antiretroviral therapy treatment remain at increased risk for ischemic outcomes such as myocardial infarction and stroke relative to the persons without HIV. Unique features of HIV-related cardiovascular disease, in part, include the pathogenesis of coronary disease characterized by remodeling ectasia and unusual plaque morphology, the relative high proportion of type 2 myocardial infarction events, abnormalities of the aorta such as aneurysms and diffuse aortic inflammation, and HIV cerebrovasculopathy as a contributor to stroke risk. Literature over the past decade has also reflected a shift in the profile and prevalence of HIV-associated heart failure, with a reduced but persistent risk of heart failure with reduced ejection fraction and a growing risk of heart failure with preserved ejection fraction. Cardiac magnetic resonance imaging and autopsy data have emphasized the central importance of intramyocardial fibrosis for the pathogenesis of both heart failure with preserved ejection fraction and the increase in risk of sudden cardiac death. Still, more research is needed to better characterize the underlying mechanisms and clinical phenotype of HIV-associated myocardial disease in the current era. Across the different cardiovascular disease manifestations, a common pathogenic feature is that HIV-associated inflammation working through different mechanisms may amplify underlying pathology because of traditional risk and other host factors. The prevalence and phenotype of individual cardiovascular disease manifestations is ultimately influenced by the degree of injury from HIV disease combined with the profile of underlying cardiometabolic factors, both of which may differ substantially by region globally.
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Affiliation(s)
- Mpiko Ntsekhe
- Division of Cardiology, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa (M.N.)
| | - Jason V Baker
- Division of Infectious Diseases, Hennepin Healthcare Research Institute, Minneapolis, MN (J.V.B.).,Department of Medicine, University of Minnesota, Minneapolis (J.V.B.)
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Hodas R, Benedek I, Rat N, Kovacs I, Chitu M, Benedek T. Impact of COVID-19 Pandemic on STEMI Networks in Central Romania. Life (Basel) 2021; 11:1004. [PMID: 34685376 PMCID: PMC8538660 DOI: 10.3390/life11101004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has had a major impact on cardiovascular emergencies. The aim of this study was to investigate the impact of the COVID-19 pandemic on a regional network for management of ST-segment elevation acute myocardial infarction (STEMI). METHODS We report a single center's experience of patients hospitalized for ACS in a high-volume hub of a STEMI network during the lockdown (in the first pandemic trimester), compared with the same time interval of the previous year and including all consecutive patients referred for an AMI during the second trimester of 2020 (from April to June) or during the same time interval of the previous year, 2019. RESULTS The absolute number of hospital admissions for AMI decreased by 22.3%, while the non-AMI hospitalizations decreased by 77.14% in Q2-2020 compared to Q2-2019 (210 vs. 48, p < 0.0001). As a consequence, the percentage of AMI cases from the total number of hospital admission increased from 38% to 68% (p < 0.0001), AMI becoming the dominant pathology. In the STEMI group there was a significant reduction of 55% in the absolute number of late STEMI presentations. Functionality of the STEMI network at the hub level did not present a significant alteration with only a minor increase in the door-to-balloon time, from 34 min to 41 min. However, at the level of the network we recorded a lower number of critical cases transferred to the interventional center, with a dramatic reduction of 56.1% in the number of critical STEMI cases arriving in the acute cardiac care unit (17.0% vs. 7.3%, p-0.04 for KILLIP class III, and 21.17% vs. 11.11%, p = 0.08 for resuscitated out of hospital cardiac arrest). CONCLUSIONS The COVID-19 outbreak did not have a major impact on the interventional center's functionality, but it limited the capacity of the regional STEMI network to bring the critical patient with complicated STEMI to the cathlab in time during the first months of the lockdown. Even a very well-functioning STEMI network like the one in Central Romania had difficulties bringing the most critical STEMI cases to the cathlab in time.
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Affiliation(s)
- Roxana Hodas
- Pharmacy, Science and Technology of Targu Mures, George Emil Palade University of Medicine, 540142 Tirgu Mures, Romania; (R.H.); (I.B.); (I.K.); (M.C.); (T.B.)
- Clinic of Cardiology, Emergency Clinical County Hospital, 540136 Tirgu Mures, Romania
| | - Imre Benedek
- Pharmacy, Science and Technology of Targu Mures, George Emil Palade University of Medicine, 540142 Tirgu Mures, Romania; (R.H.); (I.B.); (I.K.); (M.C.); (T.B.)
- Clinic of Cardiology, Emergency Clinical County Hospital, 540136 Tirgu Mures, Romania
| | - Nora Rat
- Pharmacy, Science and Technology of Targu Mures, George Emil Palade University of Medicine, 540142 Tirgu Mures, Romania; (R.H.); (I.B.); (I.K.); (M.C.); (T.B.)
- Clinic of Cardiology, Emergency Clinical County Hospital, 540136 Tirgu Mures, Romania
| | - Istvan Kovacs
- Pharmacy, Science and Technology of Targu Mures, George Emil Palade University of Medicine, 540142 Tirgu Mures, Romania; (R.H.); (I.B.); (I.K.); (M.C.); (T.B.)
- Clinic of Cardiology, Emergency Clinical County Hospital, 540136 Tirgu Mures, Romania
| | - Monica Chitu
- Pharmacy, Science and Technology of Targu Mures, George Emil Palade University of Medicine, 540142 Tirgu Mures, Romania; (R.H.); (I.B.); (I.K.); (M.C.); (T.B.)
- Clinic of Cardiology, Emergency Clinical County Hospital, 540136 Tirgu Mures, Romania
| | - Theodora Benedek
- Pharmacy, Science and Technology of Targu Mures, George Emil Palade University of Medicine, 540142 Tirgu Mures, Romania; (R.H.); (I.B.); (I.K.); (M.C.); (T.B.)
- Clinic of Cardiology, Emergency Clinical County Hospital, 540136 Tirgu Mures, Romania
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Mondal P, Aljizeeri A, Small G, Malhotra S, Harikrishnan P, Affandi JS, Buechel RR, Dwivedi G, Al-Mallah MH, Jain D. Coronary artery disease in patients with human immunodeficiency virus infection. J Nucl Cardiol 2021; 28:510-530. [PMID: 32820424 DOI: 10.1007/s12350-020-02280-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/01/2020] [Indexed: 01/02/2023]
Abstract
The life expectancy of people infected with human immunodeficiency virus (HIV) is rising due to better access to combination anti-retroviral therapy (ART). Although ART has reduced acquired immune deficiency syndrome (AIDS) related mortality and morbidity, there has been an increase in non-AIDS defining illnesses such as diabetes mellitus, hypercholesterolemia and coronary artery disease (CAD). HIV is a disease marked by inflammation which has been associated with specific biological vascular processes increasing the risk of premature atherosclerosis. The combination of pre-existing risk factors, atherosclerosis, ART, opportunistic infections and coagulopathy contributes to rising CAD incidence. The prevalence of CAD has emerged as a major contributor of morbidity in these patients due to longer life expectancy. However, ART has been associated with lipodystrophy, dyslipidemia, insulin resistance, diabetes mellitus and CAD. These adverse effects, along with drug-drug interactions when ART is combined with cardiovascular drugs, result in significant challenges in the care of this group of patients. Exercise tolerance testing, echocardiography, myocardial perfusion imaging, coronary computed tomography angiography and magnetic resonance imaging help in the diagnosis of CAD and heart failure and help predict cardiovascular outcomes in a manner similar to non-infected individuals. This review will highlight the pathogenesis and factors that link HIV to CAD, presentation and treatment of HIV-patients presenting with CAD and review briefly the cardiac imaging modalities used to identify this entity and help prognosticate future outcomes.
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Affiliation(s)
- Pratik Mondal
- Department of Cardiology and Nuclear Cardiovascular Imaging Laboratory, New York Medical College, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA
| | - Ahmed Aljizeeri
- King Abdulaziz Cardiac Center, Ministry of National Guard-Health Affaire, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Gary Small
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | | | | | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Girish Dwivedi
- Fiona Stanley Hospital, Murdoch, WA, Australia
- Harry Perkins Institute of Medical Research, Murdoch, WA, Australia
- The University of Western Australia, Crawley, WA, Australia
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Diwakar Jain
- Department of Cardiology and Nuclear Cardiovascular Imaging Laboratory, New York Medical College, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA.
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D'Ascenzo F, De Filippo O, Borin A, Barbieri L, Adamo M, Morici N, Truffa Giachet A, Iannaccone M, Crimi G, Gaido L, Bocchino PP, Pivato CA, Campo G, Trabattoni D, Chieffo A, Gaibazzi N, Angelini F, Rubboli A, Rognoni A, Musumeci G, Ugo F, Gili S, Cortese B, Vadalà P, Dusi V, Gallone G, Patti G, de Ferrari GM. Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry. Int J Cardiol 2021; 332:227-234. [PMID: 33794235 PMCID: PMC8006512 DOI: 10.1016/j.ijcard.2021.03.063] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/04/2021] [Accepted: 03/22/2021] [Indexed: 12/22/2022]
Abstract
Introduction The impact of Covid-19 on the survival of patients presenting with acute coronary syndrome (ACS) remains to be defined. Methods Consecutive patients presenting with ACS at 18 Centers in Northern-Italy during the Covid-19 outbreak were included. In-hospital all-cause death was the primary outcome. In-hospital cardiovascular death along with mechanical and electrical complications were the secondary ones. A case period (February 20, 2020-May 3, 2020) was compared vs. same-year (January 1–February 19, 2020) and previous-year control periods (February 20–May 3, 2019). ACS patients with Covid-19 were further compared with those without. Results Among 779 ACS patients admitted during the case period, 67 (8.6%) tested positive for Covid-19. In-hospital all-cause mortality was significantly higher during the case period compared to the control periods (6.4% vs. 3.5% vs. 4.4% respectively; p 0.026), but similar after excluding patients with COVID-19 (4.5% vs. 3.5% vs. 4.4%; p 0.73). Cardiovascular mortality was similar between the study groups. After multivariable adjustment, admission for ACS during the COVID-19 outbreak had no impact on in-hospital mortality. In the case period, patients with concomitant ACS and Covid-19 experienced significantly higher in-hospital mortality (25% vs. 5%, p < 0.001) compared to patients without. Moreover, higher rates of cardiovascular death, cardiogenic shock and sustained ventricular tachycardia were found in Covid-19 patients. Conclusion ACS patients presenting during the Covid-19 pandemic experienced increased all-cause mortality, driven by Covid-19 positive status due to higher rates of cardiogenic shock and sustained ventricular tachycardia. No differences in cardiovascular mortality compared to non-pandemic scenarios were reported.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy.
| | - Andrea Borin
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Lucia Barbieri
- Division of Cardiology, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Nuccia Morici
- Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Italy
| | | | | | - Gabriele Crimi
- Cardiovascular Disease Unit, Istituto di Ricerca e Cura a Carattere Scientifico Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genova, Italy
| | - Luca Gaido
- Division of Cardiology, Ospedale Maria Vittoria, Torino, Italy
| | - Pier Paolo Bocchino
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Carlo Andrea Pivato
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy.; Department of Biomedical Sciences - Pieve Emanuele, Humanitas University, Milano, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
| | - Daniela Trabattoni
- Invasive Cardiology Unit 3, Centro Cardiologico Monzino, IRCCS, Via Parea, 4 - 20138 Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Rubboli
- Division of Cardiology, S Maria delle Croci Hospital, Ravenna, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Giuseppe Musumeci
- Cardiology Department, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
| | - Fabrizio Ugo
- Division of Cardiology, Presidio Ospedaliero Sant'Andrea di Vercelli, Vercelli, Italy
| | - Sebastiano Gili
- Invasive Cardiology Unit 3, Centro Cardiologico Monzino, IRCCS, Via Parea, 4 - 20138 Milan, Italy
| | - Bernardo Cortese
- San Carlo Clinic, Milan, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| | - Paolo Vadalà
- Division of Cardiology, Ospedale Michele e Pietro Ferrero, Verduno, Italy
| | - Veronica Dusi
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Giuseppe Patti
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gaetano Maria de Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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7
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Gallone G, D'Ascenzo F, De Ferrari GM. Coronary artery disease in patients with HIV: A call for clinical evidence to inform tailored treatment strategies. Trends Cardiovasc Med 2021; 32:170-171. [PMID: 33744416 DOI: 10.1016/j.tcm.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Torino, Italy, Corso Bramante 88/90, 10126 Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Torino, Italy, Corso Bramante 88/90, 10126 Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Torino, Italy, Corso Bramante 88/90, 10126 Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
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Severino P, D’Amato A, Pucci M, Infusino F, Adamo F, Birtolo LI, Netti L, Montefusco G, Chimenti C, Lavalle C, Maestrini V, Mancone M, Chilian WM, Fedele F. Ischemic Heart Disease Pathophysiology Paradigms Overview: From Plaque Activation to Microvascular Dysfunction. Int J Mol Sci 2020; 21:E8118. [PMID: 33143256 PMCID: PMC7663258 DOI: 10.3390/ijms21218118] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
Ischemic heart disease still represents a large burden on individuals and health care resources worldwide. By conventions, it is equated with atherosclerotic plaque due to flow-limiting obstruction in large-medium sized coronary arteries. However, clinical, angiographic and autoptic findings suggest a multifaceted pathophysiology for ischemic heart disease and just some cases are caused by severe or complicated atherosclerotic plaques. Currently there is no well-defined assessment of ischemic heart disease pathophysiology that satisfies all the observations and sometimes the underlying mechanism to everyday ischemic heart disease ward cases is misleading. In order to better examine this complicated disease and to provide future perspectives, it is important to know and analyze the pathophysiological mechanisms that underline it, because ischemic heart disease is not always determined by atherosclerotic plaque complication. Therefore, in order to have a more complete comprehension of ischemic heart disease we propose an overview of the available pathophysiological paradigms, from plaque activation to microvascular dysfunction.
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Affiliation(s)
- Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Andrea D’Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Mariateresa Pucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Fabio Infusino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Francesco Adamo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Lucrezia Netti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Giulio Montefusco
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
| | - William M. Chilian
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (P.S.); (A.D.); (M.P.); (F.I.); (F.A.); (L.I.B.); (L.N.); (G.M.); (C.C.); (C.L.); (V.M.); (M.M.)
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9
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McLaughlin MM, Ma Y, Scherzer R, Rahalkar S, Martin JN, Mills C, Milush J, Deeks SG, Hsue PY. Association of Viral Persistence and Atherosclerosis in Adults With Treated HIV Infection. JAMA Netw Open 2020; 3:e2018099. [PMID: 33119103 PMCID: PMC7596582 DOI: 10.1001/jamanetworkopen.2020.18099] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Persons living with HIV (PLWH) have increased risk for cardiovascular disease, and inflammation is thought to contribute to this excess risk. Production of HIV during otherwise effective antiretroviral therapy (ART) has been associated with inflammation. OBJECTIVE To determine whether higher levels of viral persistence are associated with atherosclerosis as assessed by changes in carotid artery intima-media thickness (IMT) over time. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, intima-media thickness, a validated marker of atherosclerosis, was assessed over time in a cohort of treated PLWH with viral suppression. Cell-associated HIV DNA and RNA and change in IMT, adjusted for demographics, cardiovascular risk factors, and HIV-related factors, were examined, as well as which factors were associated with viral persistence. One hundred fifty-two PLWH with undetectable viral loads for at least 6 months before study enrollment were recruited from HIV clinics affiliated with 2 hospitals in San Francisco, California, from January 1, 2003, to December 31, 2012. Data were analyzed from February 7, 2018, to May 12, 2020. EXPOSURES Cell-associated HIV RNA and DNA were measured using enriched CD4+ T cells from cryopreserved peripheral blood mononuclear cells. MAIN OUTCOMES AND MEASURES Carotid IMT was measured at baseline and the last visit, with a mean (SD) follow-up of 4.2 (2.7) years, using high-resolution B mode ultrasonography. The main study outcomes were baseline IMT, annual IMT progression, and incident plaque, defined as a focal region of carotid IMT of greater than 1.5 mm. RESULTS The analysis included 152 PLWH (140 [92.1%] male; median age, 48.5 [interquartile range {IQR}, 43.3-53.7] years). Older age, smoking, medications for hypertension, higher low-density lipoprotein levels, and higher interleukin 6 levels were associated with higher baseline mean IMT, whereas cell-associated HIV DNA (estimate, -0.07% [95% CI, -6.1% to 6.4%]; P = .98), and HIV RNA levels (estimate, -0.8% [95% CI, -5.9% to 4.4%]; P = .75) were not. Levels of HIV RNA (0.017 [95% CI, 0.000-0.034] mm/y; P = .047) and HIV DNA (0.022 [95% CI, 0.001-0.044] mm/y; P = .042) were significantly associated with annual carotid artery IMT progression in unadjusted models only. Both HIV RNA (incidence risk ratio [IRR], 3.05 [95% CI, 1.49-6.27] per IQR; P = .002) and HIV DNA (IRR, 3.15 [95% CI, 1.51-6.57] per IQR; P = .002) were significantly associated with incident plaque, which remained significant after adjusting for demographics, cardiovascular risk factors, and HIV-related factors (IRR for HIV RNA, 4.05 [95% CI, 1.44-11.36] per IQR [P = .008]; IRR for HIV DNA, 3.35 [95% CI, 1.22-9.19] per IQR [P = .02]). Higher C-reactive protein levels were associated with higher cell-associated HIV RNA (estimate, 20.7% [95% CI, 0.9%-44.4%] per doubling; P = .04), whereas higher soluble CD14 levels were associated with HIV DNA (estimate, 18.6% [95% CI, 3.5%-35.8%] per 10% increase; P = .01). Higher soluble CD163 levels were associated with a higher HIV RNA:DNA ratio (difference, 63.8% [95% CI, 3.5%-159.4%]; P = .04). CONCLUSIONS AND RELEVANCE These findings suggest that measurements of viral persistence in treated HIV disease are independently associated with incident carotid plaque development. The size and transcriptional activity of the HIV reservoir may be important contributors to HIV-associated atherosclerosis.
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Affiliation(s)
| | - Yifei Ma
- Department of Medicine, San Francisco Veterans Affairs Medical Center, UCSF
| | - Rebecca Scherzer
- Department of Medicine, San Francisco Veterans Affairs Medical Center, UCSF
| | - Smruti Rahalkar
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, UCSF
| | | | - Claire Mills
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, UCSF
| | - Jeffrey Milush
- Department of Medicine, Division of Experimental Medicine, UCSF
| | - Steven G. Deeks
- Positive Health Program, San Francisco General Hospital, San Francisco, California
| | - Priscilla Y. Hsue
- Division of Cardiology, Department of Medicine, San Francisco General Hospital, UCSF
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10
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Boccara F, Mary-Krause M, Potard V, Teiger E, Lang S, Hammoudi N, Chauvet M, Ederhy S, Dufour-Soulat L, Ancedy Y, Nhan P, Adavane S, Steg PG, Funck-Brentano C, Costagliola D, Cohen A. HIV Infection and Long-Term Residual Cardiovascular Risk After Acute Coronary Syndrome. J Am Heart Assoc 2020; 9:e017578. [PMID: 32844734 PMCID: PMC7660787 DOI: 10.1161/jaha.119.017578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background It is unclear whether HIV infection affects the long-term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV-uninfected (HIV-) patients, and to identify determinants of cardiovascular prognosis. Methods and Results Consecutive PLHIV and matched HIV- patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36-month follow-up. A total of 103 PLHIV and 195 HIV- patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow-up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- patients (17.8% and 15.1%, P=0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67-3.82 [P=0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32-30.21 [P=0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%; P=0.01) and had smaller total cholesterol decreases (-22.3 versus -35.0 mg/dL; P=0.04). Conclusions Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV- individuals, PLHIV had a higher rate of recurrent ACS. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00139958.
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Affiliation(s)
- Franck Boccara
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France.,National Institute of Health and Medical Research INSERM UMR_S 938 Sorbonne Université Paris France
| | - Murielle Mary-Krause
- INSERM Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Sorbonne Université Paris France
| | - Valérie Potard
- INSERM Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Sorbonne Université Paris France
| | - Emmanuel Teiger
- Interventional Cardiology Unit Henri Mondor University Hospital Assistance Publique Hôpitaux de Paris Créteil France.,Inserm CIC 1430 et U955 Team 3 Henri Mondor University Hospital Créteil France
| | - Sylvie Lang
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Nadjib Hammoudi
- Inserm UMRS 1166 Institute of Cardiometabolism and Nutrition (ICAN) ACTION Study Group and Institute of Cardiology (AP-HP) Hôpital Pitié-Salpêtrière Sorbonne Université Paris France
| | - Marion Chauvet
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Stéphane Ederhy
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Laurie Dufour-Soulat
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Yann Ancedy
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Pascal Nhan
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Saroumadi Adavane
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
| | - Ph Gabriel Steg
- Département Hospitalo-Universitaire (DHU) Fibrose Inflammation Remodelage (FIRE) INSERM U-1148 University Paris Diderot Assistance Publique - Hôpitaux de Paris (AP-HP) Paris France
| | - Christian Funck-Brentano
- Department of Pharmacology INSERM CIC Paris-Est, AP-HP ICAN Pitié-Salpêtrière Hospital Sorbonne Université Paris France
| | - Dominique Costagliola
- INSERM Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP) Sorbonne Université Paris France
| | - Ariel Cohen
- Department of Cardiology Faculty of Medicine AP-HP Hôpitaux de l'Est Parisien Hôpital Saint-Antoine Sorbonne Université Paris France
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11
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Arzhakova MA, Shekhovtsova TA, Duplyakov DV. Coronary Heart Disease in HIV-Infected Patients. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2019-15-6-900-905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Currently, there are methods of drug exposure to the infection caused by the human immunodeficiency viruses (HIV), that allow to suppress the active replication of the virus in the patient's body. The era of antiretroviral therapy, which has allowed HIV-infected people to live longer, has begun. This led to an increase in their cardiovascular diseases, which occur at an earlier age and are more severe than in people without HIV. Specific or “nontraditional” risk factors damaging vascular wall occur in HIV patients along with traditional risk factors. These factors include: the negative impact of HIV on endothelium, an imbalance of inflammatory mediators, pathological immune activation, a decrease in the level of CD4 cells, a change in the number and function of platelets. The question of the effect of antiretroviral therapy on the occurrence of atherosclerotic vascular lesions remains debatable. Acute coronary syndrome (ACS) is one of the most frequent and most severe cardiovascular events in HIV-infected patients. The risk of myocardial infarction is highest in patients with a viral load of HIV-1 ribonucleic acid (RNA)≥500 copies/ml and a CD4 cell count of <200/ml. The most common form of ACS in HIV patients is ACS with ST segment elevation. Treatment of ACS in HIV patients has some difficulties: a high frequency of stent thrombosis, the frequent occurrence of thrombocytopenia, drug interactions with antiretroviral therapy. The high risk of developing cardiovascular diseases in HIV patients necessitates the introduction of active measures of primary and secondary prevention, taking into account the specific interaction of all drugs taken by the patient.
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Affiliation(s)
| | | | - D. V. Duplyakov
- Samara State Medical University;
Samara Regional Clinical Cardiology Dispensary
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12
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Abstract
Antiretroviral therapy has largely transformed HIV infection into a chronic disease condition. As such, physicians and other providers caring for individuals living with HIV infection need to be aware of the potential cardiovascular complications of HIV infection and the nuances of how HIV infection increases the risk of cardiovascular diseases, including acute myocardial infarction, stroke, peripheral artery disease, heart failure and sudden cardiac death, as well as how to select available therapies to reduce this risk. In this Review, we discuss the epidemiology and clinical features of cardiovascular disease, with a focus on coronary heart disease, in the setting of HIV infection, which includes a substantially increased risk of myocardial infarction even when the HIV infection is well controlled. We also discuss the mechanisms underlying HIV-associated atherosclerotic cardiovascular disease, such as the high rates of traditional cardiovascular risk factors in patients with HIV infection and HIV-related factors, including the use of antiretroviral therapy and chronic inflammation in the setting of effectively treated HIV infection. Finally, we highlight available therapeutic strategies, as well as approaches under investigation, to reduce the risk of cardiovascular disease and lower inflammation in patients with HIV infection.
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Affiliation(s)
- Priscilla Y Hsue
- University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
| | - David D Waters
- University of California-San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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13
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Bernelli C, Danzi GB, Cerrato E, Pierini S, Ornaghi MG, Botta L, Gentile F, Migliorino GM, Squillace N. Cardiovascular Events Recurrence and Coronary Artery Disease in HIV Patients: The Price We Have to Pay for the Chronicization of the Disease. Can J Cardiol 2019; 36:127-134. [PMID: 31813674 DOI: 10.1016/j.cjca.2019.07.636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022] Open
Abstract
The introduction of combination of antiretroviral therapy and advancement in care of HIV have dramatically changed the natural history of patients living with HIV. Today, HIV+ patients have a life expectancy not significantly different from HIV uninfected people. However, concerns remain about all the comorbidities associated with aging and the effects of chronic therapies in such high-risk patients. HIV+ subjects exhibited accelerated atherosclerosis and have a 1.5- to 2-fold increased risk of having coronary artery disease (CAD), usually presenting early and aggressively with acute coronary events. Furthermore, HIV+ patients with CAD often complain recurrent acute coronary events, and they are plagued by major adverse cardiac outcomes. This review will focus on the current understanding of the CAD phenotype in HIV+ patients highlighting the topic of acute coronary event recurrence and underscoring the role of percutaneous management strategies in the light of information derived from invasive coronary imaging.
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Affiliation(s)
- Chiara Bernelli
- Interventional Cardiology Unit, Ospedale Santa Corona, Pietra Ligure, Italy.
| | | | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli degli Infermi Hospital, Rivoli, Turin, Italy
| | - Simona Pierini
- Interventional Cardiology Unit ASST Nord-Milano, Ospedale Bassini, Via Massimo Gorki, Milano, Italy
| | | | - Luca Botta
- Cardiac surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, Milano, Italy
| | - Francesco Gentile
- Interventional Cardiology Unit ASST Nord-Milano, Ospedale Bassini, Via Massimo Gorki, Milano, Italy
| | - Guglielmo Marco Migliorino
- Infectious Diseases Unit, Azienda Socio-Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Nicola Squillace
- Infectious Diseases Unit, Azienda Socio-Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
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14
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Peyracchia M, Verardi R, Rubin SR, Abu-Assi E, Montrucchio C, Perl L, Grossomarra W, Calcagno A, Omedè P, Montefusco A, Bonora S, Moretti C, D'Amico M, Mauro R, D'Ascenzo F. In-hospital and long-term outcomes of HIV-positive patients undergoing PCI according to kind of stent: a meta-analysis. J Cardiovasc Med (Hagerstown) 2019; 20:321-326. [PMID: 30664538 DOI: 10.2459/jcm.0000000000000767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pathogenesis of cardiovascular disease in HIV-positive patients is related to the interaction between traditional and HIV-specific factors. Limited data are available regarding the prognosis of HIV-positive patients undergoing percutaneous coronary intervention (PCI). METHODS All observational studies evaluating the prognosis of HIV-positive patients treated with PCI were included. In-hospital and long-term major adverse cardiac events (MACE) [composite endpoint of all-cause death or myocardial infarction (MI)] were the primary endpoints, whereas in-hospital and long-term all-cause death, cardiovascular death, MI, stent thrombosis, target vessel revascularization (TVR), target lesion revascularization (TLR), and bleeding complications were the secondary ones. FINDINGS In all, 1243 patients in nine studies were included, with a mean age of 54 years. Among them, 12% were female and 91% were admitted for acute coronary syndromes. In-hospital MACE occurred in 6.0% (5.4-6.6), death in 4.2% (2.6-5.9), and MI in 1.3% (0-2.8), whereas major bleeding occurred in 2.0% (1.7-2.3) of the patients. After 2 years (1.6-3.1), long-term MACE occurred in 17.4% (11.9-22.3), all-cause death in 8.7% (3.2-14.2), and MI in 7.8% (5.5-10.1) of the patients, whereas stent thrombosis and TVR in 3.4% (1.5-5.3) and 10.5% (7.5-13.4), respectively. In patients treated with drug-eluting stents (DES), the rate of long-term MACE was 22.3% (10.1-34.4), with an incidence of 4.9% (0.0-11.4) of MI and 5.7% (2.3-13.7, all 95% confidence intervals of TLR. INTERPRETATION HIV-positive patients have a high risk of in-hospital and long-term MACE after PCI, partially reduced by the use of DES. Further studies on the risk of recurrent ischemic events with current generation stents are needed, to offer a tailored therapy in this high-risk population.
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Affiliation(s)
- Mattia Peyracchia
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Roberto Verardi
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Sergio Raposeiras Rubin
- Department of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña
| | - Emad Abu-Assi
- Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | - Leor Perl
- Cardiology Department, Rabin Medical Center, Petach-Tikva and the "Sackler" Faculty of Medicine, Tel-Aviv University, Israel
| | - Walter Grossomarra
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Division of Infectious Disease, University of Turin, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Bonora
- Division of Infectious Disease, University of Turin, Turin, Italy
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Rinaldi Mauro
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
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15
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Biolè C, Huczek Z, Nuñez-Gil I, Boccuzzi G, Autelli M, Montefusco A, Trabattoni D, Ryan N, Venuti G, Imori Y, Takano H, Matsuda J, Shimizu W, Muscoli S, Montabone A, Wojakowski W, Rognoni A, Helft G, Gallo D, Parma R, De Luca L, Figini F, Mitomo S, Pennone M, Mattesini A, Templin C, Quadri G, Wańha W, Cerrato E, Smolka G, Protasiewicz M, Kuliczkowski W, Rolfo C, Cortese B, Capodanno D, Chieffo A, Morbiducci U, Iannaccone M, Gili S, di Mario C, D'Amico M, Romeo F, Lüscher TF, Sheiban I, Escaned J, Varbella F, D'Ascenzo F. Daily risk of adverse outcomes in patients undergoing complex lesions revascularization: A subgroup analysis from the RAIN-CARDIOGROUP VII study (veRy thin stents for patients with left mAIn or bifurcatioN in real life). Int J Cardiol 2019; 290:64-69. [PMID: 30971372 DOI: 10.1016/j.ijcard.2019.03.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) for complex lesions, including unprotected left main (ULM) and bifurcations, is gaining a relevant role in treating coronary artery disease with good outcomes, also thanks to new generation stents. The daily risk of adverse cardiovascular events and their temporal distribution after these procedures is not known. METHODS All consecutive patients presenting with a critical lesion of ULM or bifurcation treated with very thin struts stents, enrolled in the RAIN-Cardiogroup VII study, were analyzed. The daily risk of major acute cardiovascular events (MACE), target lesion revascularization (TLR) and stent thrombosis (ST) and their temporal distribution in the first year of follow-up was the primary endpoint. Differences among subgroups (ULM, patient presentation, kind of stent polymer) were the secondary endpoint. RESULTS 2745 patients were included, mean age 68 ± 11 years, 33.3% diabetics, 54.5% had an acute coronary syndrome (ACS); 88.5% of treated lesions were bifurcations, 27.2% ULM. Average daily risk was 0.022% for MACE, 0.005% for TLR and 0.004% for ST, in the first year. Bimodal distribution of adverse events, especially TLR, with an early peak in the first 50 days and a late one after 150 days, was observed. Patients with ULM presented a significantly higher daily risk of events, and ACS patients presented higher MACE risk. No difference emerged according to the type of stent polymer. CONCLUSIONS The daily risk of adverse events in the first year after complex PCI in our study is acceptably low. PCI on ULM carries a higher risk of complications.
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Affiliation(s)
- Carloalberto Biolè
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy.
| | | | - Ivan Nuñez-Gil
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Michele Autelli
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, Milan, Italy; University of Milan, Milan, Italy
| | - Nicola Ryan
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Giuseppe Venuti
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Junya Matsuda
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Saverio Muscoli
- San Raffaele Scientific Institute, Milan, Italy; Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | - Andrea Montabone
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy
| | | | - Leonardo De Luca
- Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli, Rome, Italy
| | | | | | - Mauro Pennone
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Giorgio Quadri
- Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Wojciech Wańha
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Enrico Cerrato
- Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Grzegorz Smolka
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | | | | | - Cristina Rolfo
- Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Bernardo Cortese
- Interventional Cardiology, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Davide Capodanno
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Catania, Italy
| | | | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy
| | - Mario Iannaccone
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Sebastiano Gili
- Division of Cardiology, Universityszpital of Zurich, Switzerland
| | - Carlo di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Francesco Romeo
- Department of Medicine, Università degli Studi di Roma 'Tor Vergata', Rome, Italy
| | - Thomas F Lüscher
- Division of Cardiology, Universityszpital of Zurich, Switzerland
| | | | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Ferdinando Varbella
- Department of Cardiology, Infermi Hospital, Rivoli, Italy; Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Departement of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
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Mechanisms of Cardiovascular Disease in the Setting of HIV Infection. Can J Cardiol 2018; 35:238-248. [PMID: 30825947 DOI: 10.1016/j.cjca.2018.12.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/12/2022] Open
Abstract
Although the initial reports of increased cardiovascular (CV) disease in the setting of advanced AIDS were reported approximately 30 years ago, advances in antiretroviral therapy and immediate initiation of therapy on diagnosis have transformed what was once a deadly infectious disease into a chronic health condition. Accordingly, the types of CV diseases occurring in HIV have shifted from pericardial effusions and dilated cardiomyopathy to atherosclerosis and heart failure. The underlying pathophysiology of HIV-associated CV disease remains poorly understood, partly because of the rapidly evolving nature of HIV treatment and because clinical endpoints take many years to develop. The gut plays an important role in the early pathogenesis of HIV infection as HIV preferentially infects CD4+ T cells, 80% of which are located in gut mucosa. The loss of these T cells damages gut mucosa resulting in increased gut permeability and microbial translocation, which incites chronic inflammation and immune activation. Antiretroviral therapy does not cure HIV infection and immune abnormalities persist. These abnormalities correlate with mortality and CV events. The effects of antiretroviral therapy on CV risk are complex; treatment reduces inflammation and other markers of CV risk but induces lipid abnormalities, most commonly hypertriglyceridemia. On a molecular level, monocytes/macrophages, platelet reactivity, and immune cell activation, which play a role in the general population, may be heightened in the setting of HIV and contribute to HIV-associated atherosclerosis. Chronic inflammation represents an inviting therapeutic target in HIV, as it does in uninfected persons with atherosclerosis.
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17
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Sinha A, Feinstein MJ. Coronary Artery Disease Manifestations in HIV: What, How, and Why. Can J Cardiol 2018; 35:270-279. [PMID: 30825949 DOI: 10.1016/j.cjca.2018.11.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 12/24/2022] Open
Abstract
Understanding why persons with human immunodeficiency virus (HIV) have accelerated atherosclerosis and its sequelae, including coronary artery disease (CAD) and myocardial infarction, is necessary to provide appropriate care to a large and aging population with HIV. In this review, we delineate the diverse pathophysiologies underlying HIV-associated CAD and discuss how these are implicated in the clinical manifestations of CAD among persons with HIV. Several factors contribute to HIV-associated CAD, with chronic inflammation and immune activation likely representing the primary drivers. Increased monocyte activation, inflammation, and hyperlipidemia present in chronic HIV infection also mirror the pathophysiology of plaque rupture. Furthermore, mechanisms central to plaque erosion, such as activation of toll-like receptor 2 and formation of neutrophil extracellular traps, are also abundant in HIV. In addition to inflammation and immune activation in general, persons with HIV have a higher prevalence than uninfected persons of traditional cardiovascular risk factors, including dyslipidemia, hypertension, insulin resistance, and tobacco use. Antiretroviral therapies, although clearly necessary for HIV treatment and survival, have had varied effects on CAD, but newer generation regimens have reduced cardiovascular toxicities. From a clinical standpoint, this mix of risk factors is implicated in earlier CAD among persons with HIV than uninfected persons; whether the distribution and underlying plaque content of CAD for persons with HIV differs considerably from uninfected persons has not been definitively studied. Furthermore, the role of cardiovascular risk estimators in HIV remains unclear, as does the role of traditional and emerging therapies; no trials of CAD therapies powered to detect clinical events have been completed among persons with HIV.
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Affiliation(s)
- Arjun Sinha
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J Feinstein
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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18
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Foster P, Sokoll L, Li J, Gerstenblith G, Fishman EK, Kickler T, Chen S, Tai H, Lai H, Lai S. Circulating levels of cardiac troponin T are associated with coronary noncalcified plaque burden in HIV-infected adults: a pilot study. Int J STD AIDS 2018; 30:223-230. [PMID: 30381028 DOI: 10.1177/0956462418800873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HIV infection and/or antiretroviral therapy may increase the risk of subclinical coronary atherosclerosis. However, patients with chronic kidney disease (CKD) and those without IV access cannot undergo contrast-enhanced coronary CT angiography (CCTA). This study was to explore the relationship between cardiac troponin T (cTnT) levels and the extent of coronary plaque burden, as assessed by CCTA in those with HIV infection. Between June and September 2017, 58 HIV-infected participants were recruited and underwent contrast-enhanced CCTA. cTnT was measured with the Elecsys Troponin T Gen 5 STAT assay, and noncalcified plaque burden was quantified using coronary plaque analysis. Robust regression model was employed to perform primary statistical analysis. Univariate robust regression analysis indicated that male gender, cardiovascular risk score defined by the 2013 ACC/AHA cardiovascular risk score algorithm, and cTnT levels were significantly associated with noncalcified plaque volume index (NCPI). Final robust regression analyses showed that only cTnT (log scale) was independently associated with the NCPI (regression coefficient: 0.0453 with 95% CI: 0.0151, 0.0755, p = 0.003). These results of this study suggest that cTnT may be a promising marker for coronary plaque burden, especially in patients with HIV-associated CKD or without IV access.
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Affiliation(s)
- Parker Foster
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lori Sokoll
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ji Li
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gary Gerstenblith
- 2 Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elliot K Fishman
- 3 Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Thomas Kickler
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shaoguang Chen
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hong Tai
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hong Lai
- 3 Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shenghan Lai
- 1 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,2 Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,3 Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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19
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Psichogiou M, Kapelios CJ, Konstantonis G, Argyris A, Nasothimiou E, Papadopoulou M, Kitas G, Papaioannou TG, Daikos GL, Sfikakis PP, Protogerou AD. Prevalence, Incidence, and Contributors of Subclinical Atheromatosis, Arteriosclerosis, and Arterial Hypertrophy in HIV-Infected Individuals: A Single-Center, 3-Year Prospective Study. Angiology 2018; 70:448-457. [PMID: 30235944 DOI: 10.1177/0003319718801093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease (CVD) is an important comorbidity for people living with HIV infection (PLWH) in the combined antiretroviral therapy era. We prospectively examined the presence of subclinical arterial disease in 138 consecutive CVD-free, HIV-infected individuals compared to 664 HIV-negative individuals. We studied 10 arterial sites in 4 beds using 5 distinct biomarkers of subclinical atheromatosis, arteriosclerosis, and hypertrophy and evaluated the association of subclinical arterial damage with CVD-related and HIV-related factors at baseline and at 3-year follow-up. Atheromatosis, arteriosclerosis, and arterial hypertrophy were present in 36.1%, 59.7%, and 34.3% of HIV-infected individuals, respectively, at baseline. HIV infection was independently associated with carotid atheromatosis and hypertrophy. The presence of carotid atheromatosis was independently associated with age, years of smoking, and exposure to nonnucleoside reverse transcriptase inhibitors (NNRTIs). The annual incidence of atheromatosis, arteriosclerosis, and arterial hypertrophy was 5.5, 18.6, and 12.5 cases/100 patients, respectively. Carotid atheromatosis progression was significantly associated with NNRTI exposure. People living with HIV infection exhibited high prevalence and incidence of subclinical arterial damage and site-specific predilection for the carotids. These investigations may help optimize HIV-specific CVD prediction models. The NNRTIs may contribute to atheromatosis, emphasizing the need to consider the atherogenic potential of antiretroviral drugs in management strategies.
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Affiliation(s)
- Mina Psichogiou
- 1 First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University Athens School of Medicine, Athens, Greece
| | - Chris J Kapelios
- 2 Department of Cardiology, Laiko General Hospital, Athens, Greece
| | - Giorgos Konstantonis
- 3 First Department of Propaedeutic Medicine, Laiko General Hospital, National and Kapodistrian University Athens School of Medicine, Athens, Greece
| | - Antonis Argyris
- 4 Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University Athens School of Medicine, Athens, Greece
| | - Euthimia Nasothimiou
- 4 Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University Athens School of Medicine, Athens, Greece
| | - Martha Papadopoulou
- 1 First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University Athens School of Medicine, Athens, Greece
| | - George Kitas
- 5 Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Theodoros G Papaioannou
- 6 Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George L Daikos
- 1 First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University Athens School of Medicine, Athens, Greece
| | - Petros P Sfikakis
- 3 First Department of Propaedeutic Medicine, Laiko General Hospital, National and Kapodistrian University Athens School of Medicine, Athens, Greece
| | - Athanase D Protogerou
- 4 Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University Athens School of Medicine, Athens, Greece
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