Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
AIDS. 2018 Oct 23;32(16):2393-2403. doi: 10.1097/QAD.0000000000001972.
Among people with HIV, there are few long-term studies of noninvasive ultrasound-based measurements of the carotid artery predicting major health events. We hypothesized that such measurements are associated with 10-year mortality in the Women's Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS), and that associations differ by HIV serostatus.
Nested cohort study.
Participants without coronary heart disease underwent B-mode carotid artery ultrasound, with measurement of common carotid artery intima-media thickness (IMT); carotid artery plaque (focal IMT > 1.5 mm) at six locations; and Young's modulus of elasticity, a measure of arterial stiffness. We examined all-cause mortality using Cox models, controlling for demographic, behavioral, cardiometabolic, and HIV-related factors.
Among 1722 women (median age 40 years, 90% nonwhite, 71% HIV-positive) and 1304 men (median age 50, 39% nonwhite, 62% HIV-positive), 11% died during follow-up. Mortality was higher among HIV-positive women [19.9 deaths/1000 person-years, 95% confidence interval (CI) 14.7-28.8] than HIV-positive men (15.1/1000, 95% CI 8.3-26.8). In adjusted analyses, plaque was associated with mortality (hazard ratio 1.44, 95% CI 1.10-1.88) regardless of HIV serostatus, and varied by sex (among women, hazard ratio 1.06, 95% CI 0.74-1.52; among men; hazard ratio 2.19, 95% CI 1.41-3.43). The association of plaque with mortality was more pronounced among HIV-negative (hazard ratio 3.87, 95% 1.95-7.66) than HIV-positive participants (hazard ratio 1.35, 95% CI 1.00-1.84). Arterial stiffness was also associated with mortality (hazard ratio 1.43 for highest versus lowest quartile, 95% CI 1.02-2.01). Greater common carotid artery-IMT was not associated with mortality.
Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus.
在 HIV 感染者中，针对颈动脉无创超声测量预测重大健康事件的长期研究较少。我们假设这些测量与 Women's Interagency HIV Study (WIHS) 和 Multicenter AIDS Cohort Study (MACS) 的 10 年死亡率相关，并且与 HIV 血清状态有关。
嵌套队列研究。
无冠心病的参与者接受 B 型颈动脉超声检查，测量颈总动脉内膜中层厚度 (IMT)；六个部位的颈动脉斑块（局部 IMT＞1.5mm）；以及动脉弹性的杨氏模量，这是衡量动脉僵硬的指标。我们使用 Cox 模型检查全因死亡率，控制人口统计学、行为、心脏代谢和 HIV 相关因素。
在 1722 名女性（中位年龄 40 岁，90%为非白人，71%为 HIV 阳性）和 1304 名男性（中位年龄 50 岁，39%为非白人，62%为 HIV 阳性）中，随访期间有 11%的人死亡。HIV 阳性女性的死亡率更高[19.9 例/1000 人年，95%置信区间 (CI) 14.7-28.8]，高于 HIV 阳性男性[15.1/1000，95%CI 8.3-26.8]。在调整分析中，斑块与死亡率相关（危险比 1.44，95%CI 1.10-1.88），与 HIV 血清状态无关，且因性别而异（女性中，危险比 1.06，95%CI 0.74-1.52；男性中，危险比 2.19，95%CI 1.41-3.43）。与 HIV 阴性参与者相比（危险比 3.87，95%CI 1.95-7.66），与 HIV 阳性参与者相比（危险比 1.35，95%CI 1.00-1.84），斑块与死亡率的关联更为明显。动脉僵硬度也与死亡率相关（最高四分位与最低四分位相比，危险比 1.43，95%CI 1.02-2.01）。颈总动脉内膜中层厚度的增加与死亡率无关。
颈动脉斑块可预测死亡率，且性别和 HIV 血清状态存在差异。
