Flow mediated dilation and carotid intima media thickness: clinical markers or just research tools?

HIV, Combination Antiretroviral Therapy, and Vascular Diseases in Men and Women

Thanks to the advent of combination antiretroviral therapy (cART), people living with human immunodeficiency virus (HIV) (PLWH) experienced a marked increase in life expectancy but are now at higher risk for cardiovascular disease (CVD), the current leading cause of death in PLWH on cART. Although HIV preponderantly affects men over women, manifestations of HIV-related CVD differ by sex with women experiencing greater risks than men. Despite extensive investigation, the etiopathology of CVD, notably the respective contribution of viral infection and cART, remain ill-defined. However, both viral infection and cART have been reported to contribute to endothelial dysfunction, the precursor and major cause of atherosclerosis-associated CVD, through mechanisms involving endothelial cell activation, inflammation, and oxidative stress, all leading to reduced nitric oxide bioavailability. Therefore, preserving endothelial function in PLWH on cART should be a main target to reduce CVD morbidity and mortality, notably in females.

Imaging Subclinical Atherosclerosis: Where Do We Stand?

The age of initiation and the rate of progression of atherosclerosis vary markedly among individuals and have been difficult to predict with traditional cardiovascular risk assessment models. Although these risk models provide good discrimination and calibration in certain populations, cardiovascular disease (CVD) risk may not be accurately estimated in low- and intermediate risk individuals. Therefore, imaging techniques such as Ankle-Brachial Index (ABI), Coronary Artery Calcium score (CAC), carotid Intima-Media Thickness (cIMT), flow mediated dilation (FMD) and Positron Emission Tomography (PET) have been developed and used to reclassify these individuals. In the present article we review the role of the most commonly used imaging techniques for CVD risk assessment.

Central adiposity and subclinical cardiovascular disease in police officers

Given the associations between obesity and cardiovascular disease (CVD), we evaluated a related but less well-established association between waist circumference and brachial artery reactivity (BAR), a functional measurement of subclinical CVD, where lower levels indicate dysfunction. Regression models examined trends in mean BAR across waist circumference tertiles in police officers, a high-stress occupational group with increased risk for CVD. Mean BAR decreased across increasing waist tertiles among men, but not women, and this association was stronger among officers who consumed more alcohol. Larger waist circumference may be associated with lower BAR, providing an opportunity for intervention prior to disease development.