Background
In people without HIV, high Coronary Artery Calcium Scores (CACS) correlate with an increased risk of major cardiovascular and cerebrovascular events (MACE). HIV is independently associated with raised CACS, however data on factors associated with increased CACS and MACE (except smoking and diabetes) in HIV are scarce. Although knowledge on the importance of statin use to prevent MACE is clear (REPRIEVE), cost-effective investigations and interventions to identify and manage MACE in ageing people with HIV is vital.
Methods
Data were collected on all individuals with HIV, at a single centre in London, UK, who underwent a CACS between 2009-2019, including demographics, laboratory and clinical information at the time of CACS, and MACE assessed over 15 years. Descriptive statistics, univariate and multivariate regression analyses using logistic regression were performed using STATA15.
Results
Of 779 individuals with a CACS, median (IQR) age at the time of CACS was 55 years (52-59), 93% were male, median number of years since HIV-diagnosis was 16 (10-21), CD4 count was 639 (473-826), 5% had a detectable viral load (VL), 34% were current smokers, 12% reported alcohol intake >14 units/week, Qrisk2 was 9.6% (6.5-14.8), BMI was 25.5 (23.3-28.0) and systolic BP was 129 (120-140). Median (IQR) CACS was 2 (0-54) with median centile 25th-50th.
MACE occurred in 95 individuals (10.7%): 2.7% (n=21) myocardial infarction (MI), 2.3% (n=18) stroke and 3.6% (n=28) heart failure, 5.4% (n=42, of which 8 underwent coronary artery bypass grafts) revascularisation. Other outcomes included death from any cause in 6.4% (n=50). Predictors of MI, stroke or heart failure are shown in Table 1.
Conclusions
In this cohort, CACS rather than cardiovascular risk calculated by Q-risk was the strongest predictor of MACE. CACS is a useful tool in stratifying persons who would most benefit from aggressive risk factor modification and further investigation. Future understanding on whether total plaque burden on coronary CT angiography, peri-coronary fat analysis, or cardiac MRI can refine risk prediction further is needed.
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