Association of epicardial fat with noncalcified coronary plaque volume and with low attenuation plaque in people with HIV

A Blood Immunological Signature of Subclinical Coronary Artery Atherosclerosis in People Living with HIV-1 Receiving Antiretroviral Therapy

Cardiovascular disease (CVD) remains an important co-morbidity in people living with HIV-1 (PLWH) receiving antiretroviral therapy (ART). Our previous studies performed on the Canadian HIV/Aging Cohort Study (CHACS) (>40 years-old; Framingham Risk Score (FRS) >5%), revealed a 2-3-fold increase in non-calcified coronary artery atherosclerosis (CAA) plaque burden, measured by Computed tomography angiography scan (CTAScan) as total (TPV) and low attenuated plaque volume (LAPV) in ART-treated PLWH (HIV+) versus uninfected controls (HIV-). In an effort to identify novel correlates of subclinical CAA, markers of intestinal damage (sCD14, LBP, FABP2); cell trafficking/inflammation (CCL20, CX3CL1, MIF, CCL25); subsets of Th17-polarized and regulatory (Tregs) CD4 + T-cells, classical/intermediate/non-classical monocytes, and myeloid/plasmacytoid dendritic cells, were studied in relationship with HIV and TPV/LAPV status. The TPV detection/values coincided with higher plasma sCD14, FABP2, CCL20, MIF, CX3CL1 and triglyceride levels, lower Th17/Treg ratios, and classical monocyte expansion. Among HIV + , TPV + versus TPV - exhibited lower Th17 frequencies, reduced Th17/Treg ratios, higher frequencies of non-classical CCR9 low HLADR high monocyte, and increased plasma fibrinogen levels. Finally, Th17/Treg ratios and non-classical CCR9 low HLADR high monocyte frequencies remained associated with TPV/LAPV after adjusting for FRS and HIV/ART duration in a logistic regression model. These findings point to Th17 paucity and non-classical monocyte abundance as novel immunological correlates of subclinical CAA that may fuel the CVD risk in ART-treated PLWH.

The association of epicardial adipose tissue volume and density with coronary calcium in HIV-positive and HIV-negative patients

AIMS

We sought to assess and compare the association of epicardial adipose tissue (EAT) with cardiovascular disease (CVD) in HIV-positive and HIV-negative groups.

METHODS AND RESULTS

Using existing clinical databases, we analyzed 700 patients (195 HIV-positive, 505 HIV-negative). CVD was quantified by the presence of coronary calcification from both dedicated cardiac computed tomography (CT) and non-dedicated CT of the thorax. Epicardial adipose tissue (EAT) was quantified using dedicated software. The HIV-positive group had lower mean age (49.2 versus 57.8, p < 0.005), higher proportion of male sex (75.9 % versus 48.1 %, p < 0.005), and lower rates of coronary calcification (29.2 % versus 58.2 %, p < 0.005). Mean EAT volume was also lower in the HIV-positive group (68mm3 versus 118.3mm3, p < 0.005). Multiple linear regression demonstrated EAT volume was associated with hepatosteatosis (HS) in the HIV-positive group but not the HIV-negative group after adjustment for BMI (p < 0.005 versus p = 0.066). In the multivariate analysis, after adjustment for CVD risk factors, age, sex, statin use, and body mass index (BMI), EAT volume and hepatosteatosis were significantly associated with coronary calcification (odds ratio [OR] 1.14, p < 0.005 and OR 3.17, p < 0.005 respectively). In the HIV-negative group, the only significant association with EAT volume after adjustment was total cholesterol (OR 0.75, p = 0.012).

CONCLUSIONS

We demonstrated a strong and significant independent association of EAT volume and coronary calcium, after adjustment, in HIV-positive group but not in the HIV-negative group. This result hints at differences in the mechanistic drivers of atherosclerosis between HIV-positive and HIV-negative groups.

Ectopic Fat and Cardiac Health in People with HIV: Serious as a Heart Attack

PURPOSE OF REVIEW

This study aims to summarize knowledge of alterations in adipose tissue distribution among people with HIV (PWH), with a focus on the cardiac depot and how this relates to the known higher risk of cardiovascular disease in this unique population.

RECENT FINDINGS

Similar to the general population, cardiac fat depots mirror visceral adipose tissue in PWH. However, altered fat distribution, altered fat quality, and higher prevalence of enlarged epicardial adipose tissue depots are associated with increased coronary artery disease among PWH. Adipose tissue disturbances present in PWH ultimately contribute to increased risk of cardiovascular disease beyond traditional risk factors. Future research should aim to understand how regulating adipose tissue quantity and quality can modify cardiovascular risk.