HIV感染者中颈动脉斑块的存在、特征及预后关联
Presence, Characteristics, and Prognostic Associations of Carotid Plaque Among People Living With HIV.
作者信息
Janjua Sumbal A, Staziaki Pedro V, Szilveszter Balint, Takx Richard A P, Mayrhofer Thomas, Hennessy Orla, Emami Hamed A, Park Jakob, Ivanov Alexander, Hallett Travis R, Lu Michael T, Romero Javier M, Grinspoon Steven K, Hoffmann Udo, Zanni Markella V, Neilan Tomas G
机构信息
From the Cardiac MR PET CT Program, Department of Radiology (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Neuroradiology Division, Department of Radiology (J.M.R.), Program in Nutritional Metabolism (S.K.G., M.V.Z.), and Division of Cardiology, Department of Medicine (S.A.J., P.V.S., B.S., R.A.P.T., T.M., O.H., H.A.E., J.P., A.I., T.R.H., M.T.L., U.H., T.G.N.), Massachusetts General Hospital and Harvard Medical School, Boston.
出版信息
Circ Cardiovasc Imaging. 2017 Oct;10(10). doi: 10.1161/CIRCIMAGING.116.005777.
BACKGROUND
Data from broad populations have established associations between incidental carotid plaque and vascular events. Among people living with HIV (PLWHIV), the risk of vascular events is increased; however, whether incidental carotid plaque is increased and there is an association between incidental carotid plaque, plaque characteristics, and vascular events among PLWHIV is unclear.
METHODS AND RESULTS
Data from the multi-institutional Research Patient Data Registry were used. Presence and characteristics (high-risk plaque, including spotty calcification and low attenuation) of carotid plaque by computerized tomography among PLWHIV without known vascular disease were described. Data were compared with uninfected controls similar in age, sex, and cardiovascular risk factors, including diabetes mellitus, hyperlipidemia, and cigarette smoking to cases. Primary outcome was an atherosclerotic cardiovascular disease event, and secondary outcome was ischemic stroke. Cohort consisted of 209 PLWHIV (45±10 years, 72% male) and 168 controls. Using computerized tomography, PLWHIV without vascular disease had higher rates of any carotid plaque (34% versus 25%; =0.04), noncalcified (18% versus 5%; <0.001) and high-risk plaque (25% versus 16%; =0.03). Over a follow-up of 3 years, 19 atherosclerotic cardiovascular disease events (9 strokes) occurred. Carotid plaque was independently associated with a 3-fold increase in atherosclerotic cardiovascular disease events among PLWHIV (hazard ratio, 2.91; confidence interval, 1.10-7.7, =0.03) and a 4-fold increased risk of stroke (hazard ratio, 4.43; confidence interval, 1.17-16.70; =0.02); high-risk plaque was associated with a 3-fold increased risk of atherosclerotic cardiovascular disease events and a 4-fold increased risk of stroke.
CONCLUSIONS
There is an increase in incidental carotid plaque, noncalcified plaque, and high-risk plaque among PLWHIV, and the presence and characteristics of carotid plaque are associated with subsequent vascular events.
背景
来自广泛人群的数据已证实偶发性颈动脉斑块与血管事件之间存在关联。在艾滋病毒感染者（PLWHIV）中，血管事件的风险增加；然而，偶发性颈动脉斑块是否增加以及PLWHIV中偶发性颈动脉斑块、斑块特征与血管事件之间是否存在关联尚不清楚。
方法和结果
使用了来自多机构研究患者数据登记处的数据。描述了无已知血管疾病的PLWHIV中通过计算机断层扫描检测到的颈动脉斑块的存在情况和特征（高危斑块，包括斑点状钙化和低衰减）。将数据与年龄、性别和心血管危险因素（包括糖尿病、高脂血症和吸烟）相似的未感染对照组进行比较。主要结局是动脉粥样硬化性心血管疾病事件，次要结局是缺血性中风。队列包括209名PLWHIV（45±10岁，72%为男性）和168名对照组。通过计算机断层扫描，无血管疾病的PLWHIV中任何颈动脉斑块的发生率更高（34%对25%；P=0.04），非钙化斑块（18%对5%；P<0.001）和高危斑块（25%对16%；P=0.03）。在3年的随访中，发生了19例动脉粥样硬化性心血管疾病事件（9例中风）。颈动脉斑块与PLWHIV中动脉粥样硬化性心血管疾病事件增加3倍独立相关（风险比，2.91；置信区间，1.10-7.7，P=0.03），中风风险增加4倍（风险比，4.43；置信区间，1.17-16.70；P=0.02）；高危斑块与动脉粥样硬化性心血管疾病事件风险增加3倍和中风风险增加4倍相关。
结论
PLWHIV中偶发性颈动脉斑块、非钙化斑块和高危斑块增加，颈动脉斑块的存在和特征与随后的血管事件相关。
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