Friday, January 15, 2010

Coronary artery plaques more serious in HIV-infected men

An MGH study has found that relatively young men with longstanding HIV infection and minimal cardiac risk factors have significantly more coronary atherosclerotic plaques -- some involving serious arterial blockage -- than do uninfected men. The report in the January 2010 issue of the journal AIDS is the first to use CT angiography to identify coronary artery plaques in HIV-infected participants.

"It appears that both traditional and nontraditional risk factors are contributing to atherosclerotic disease in HIV-infected patients," says Janet Lo, MD, MSc, of the Program in Nutritional Metabolism in the MGH Department of Medicine, who led the study. The study enrolled 110 men -- 78 with HIV infection and 32 uninfected controls -- without symptoms or elevated traditional risk factors for cardiovascular disease. After a detailed interview and examination, participants received both a standard cardiac CT scan and CT angiography. The standard scans showed that the HIV-infected participants had levels of coronary calcium that, based on previous studies, would be expected in men who were six years older. The CT angiography revealed coronary atherosclerosis in 59 percent of the HIV-infected patients, compared with only 34 percent of controls. Five of the HIV-positive participants had critical coronary stenosis -- 70 percent or greater narrowing of one or more arterial segments -- something seen in none of the controls. Those participants all were referred to cardiologists for further evaluation and treatment.

"Our findings highlight the need to address reduction of cardiac risk factors early in the course of HIV disease and for caregivers to consider that even asymptomatic patients with longstanding HIV disease and minimal cardiac risk factors may have significant coronary artery disease," says Lo.

Steven Grinspoon, MD, director of the Program in Nutritional Metabolism, is senior author of the AIDS report. Additional co-authors are Jeffrey Wei, MD, of the Program in Nutritional Metabolism, and Suhny Abbara, MD; Leon Shturman, MD; Anand Soni, MD; Jose Rocha-Filho, MD; and Khurram Nasir, MD, MPH, all of MGH Imaging.

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