抗逆转录病毒治疗的 HIV 感染者亚临床冠状动脉粥样硬化斑块的性别差异。
Sex Differences in Subclinical Coronary Atherosclerotic Plaque Among Individuals With HIV on Antiretroviral Therapy.
机构信息
Department of Radiology and Division of Cardiology, Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Endocrine Division, Program in Nutritional Metabolism, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
出版信息
J Acquir Immune Defic Syndr. 2018 Aug 1;78(4):421-428. doi: 10.1097/QAI.0000000000001686.
BACKGROUND
In high-resource settings, the HIV-attributable risk of myocardial infarction (MI) is higher among women than among men. The extent to which unique mechanisms contribute to MI risk among women vs. men with HIV remains unclear.
METHODS
Subclinical coronary atherosclerotic plaque characteristics-including high-risk morphology plaque features-were compared among 48 HIV-infected women [48 (41, 54) years] and 97 HIV-infected men [48 (42, 52) years] on stable antiretroviral therapy (ART) without known cardiovascular disease. These individuals had previously completed coronary computed tomography angiography and metabolic/immune phenotyping as part of a prospective study.
RESULTS
Extending previous analyses, now focusing exclusively on ART-treated participants, we found that HIV-infected women had a lower prevalence of any subclinical coronary atherosclerotic plaque (35% vs. 62%, P = 0.003) and a lower number of segments with plaque (P = 0.01), compared with HIV-infected men. We also report for the first time that ART-treated HIV-infected women had a lower prevalence of high-risk positively remodeled plaque (25% vs. 51%, P = 0.003) and a lower number of positively remodeled plaque segments (P = 0.002). In models adjusting for cardiovascular risk factors, we further showed that male sex remained associated with any coronary plaque [odds ratio 3.8, 95% confidence interval: (1.4 to 11.4)] and with positively remodeled plaque [odds ratio 3.7, 95% confidence interval: (1.4, 10.9)].
CONCLUSIONS
ART-treated HIV-infected women (vs. HIV-infected men) had a lower prevalence and burden of subclinical coronary plaque and high-risk morphology plaque. Thus, unique sex-specific mechanisms beyond subclinical plaque may drive the higher HIV-attributable risk of MI among women vs. men.
背景
在资源丰富的环境中，女性发生心肌梗死（MI）的 HIV 归因风险高于男性。在 HIV 感染者中，女性与男性相比，哪些独特的机制导致 MI 风险增加仍不清楚。
方法
在接受稳定抗逆转录病毒治疗（ART）且无已知心血管疾病的情况下，比较了 48 名 HIV 感染女性（48 [41，54] 岁）和 97 名 HIV 感染男性（48 [42，52] 岁）的亚临床冠状动脉粥样硬化斑块特征，包括高危形态斑块特征。这些个体之前已完成冠状动脉计算机断层血管造影和代谢/免疫表型分析，作为前瞻性研究的一部分。
结果
在之前分析的基础上，我们现在仅关注接受 ART 治疗的参与者，发现与 HIV 感染男性相比，HIV 感染女性亚临床冠状动脉粥样硬化斑块的总患病率较低（35% vs. 62%，P=0.003），斑块节段数较少（P=0.01）。我们还首次报告称，接受 ART 治疗的 HIV 感染女性高风险正性重构斑块的患病率较低（25% vs. 51%，P=0.003），正性重构斑块节段数较少（P=0.002）。在调整心血管危险因素的模型中，我们进一步表明，男性性别仍然与任何冠状动脉斑块相关[比值比 3.8，95%置信区间：（1.4 至 11.4）]，与正性重构斑块相关[比值比 3.7，95%置信区间：（1.4，10.9）]。
结论
与 HIV 感染男性（vs. HIV 感染女性）相比，接受 ART 治疗的 HIV 感染女性（vs. HIV 感染男性）亚临床冠状动脉斑块和高危形态斑块的患病率和负担较低。因此，女性与男性相比，MI 的 HIV 归因风险较高可能有独特的性别特异性机制。
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