Department of Cardiology, Laiko General Hospital, Athens, Greece.
Cardiovascular Prevention & Research Unit, Clinic and Laboratory of Pathophysiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
AIDS Res Hum Retroviruses. 2021 May;37(5):343-349. doi: 10.1089/AID.2021.0015.
The incidence of acute coronary events is increased among people living with HIV (PLWH), but there is no risk estimation score, nor a surrogate biomarker able to predict subclinical coronary artery disease (sCAD). We assessed the performance of: (i) Framingham risk score (FRMs), (ii) peripheral (carotid and femoral) artery atheromatosis, and (iii) coronary artery calcium (CACs) score, to detect the presence of sCAD, in PLWH. In a cohort of PLWH free of cardiovascular disease (CVD), we measured sCAD and CACs by computed tomography, calculated FRMs, and assessed carotid/femoral plaques by ultrasound. In 56 participants (age: 49 ± 10 years, men: 88%, FRMs: 7.2 ± 6.9; mean number of carotid/femoral plaques: 1.4 ± 1.5; CACs >0 present in 59%, median CACs 0.9 [IQR 0-22]): (i) minimal sCAD (stenosis 1%-24%; present in 30%) and mild sCAD (25%-49%, 25%) were effectively detected by FRMs, number of plaques, and CACs [area under the curve (AUC) of CACs was better than that of both FRM and plaques, < .05]; (ii) moderate sCAD (stenosis 50%-69%; present in 8.9%) was detected by number of plaques and CACs, but similar AUC (0.969 vs. 0.867, respectively, = NS); and (iii) severe sCAD (70%-99%, present in only 3 [5.4%]) was detected only by CACs. A high prevalence of sCAD in asymptomatic PLWH free of CVD was detected; CACs is a highly efficient biomarker to detect all grades of sCAD, however, the number of carotid/femoral plaques combined is also a very promising-lower cost and radiation free-surrogate biomarker. Future, larger studies are needed to verify these results.
HIV 感染者（PLWH）中急性冠脉事件的发病率增加，但目前尚无风险评估评分或替代生物标志物可预测亚临床冠状动脉疾病（sCAD）。我们评估了以下各项的表现：（i）弗雷明汉风险评分（FRMs），（ii）外周（颈动脉和股动脉）动脉粥样硬化，以及（iii）冠状动脉钙（CACs）评分，以检测 PLWH 中 sCAD 的存在。在无心血管疾病（CVD）的 PLWH 队列中，我们通过计算机断层扫描测量 sCAD 和 CACs，计算 FRMs，并通过超声评估颈动脉/股动脉斑块。在 56 名参与者（年龄：49±10 岁，男性：88%，FRMs：7.2±6.9；颈动脉/股动脉斑块的平均数量：1.4±1.5；59%存在 CACs>0，中位数 CACs 为 0.9 [IQR 0-22]）：（i）最小 sCAD（狭窄 1%-24%；存在于 30%）和轻度 sCAD（狭窄 25%-49%，25%）通过 FRMs、斑块数量和 CACs 有效检测（CACs 的曲线下面积（AUC）优于 FRM 和斑块，<0.05）；（ii）中度 sCAD（狭窄 50%-69%；存在于 8.9%）通过斑块数量和 CACs 检测，但 AUC 相似（分别为 0.969 和 0.867，=NS）；（iii）严重 sCAD（狭窄 70%-99%，仅存在于 3 例[5.4%]）仅通过 CACs 检测到。在无 CVD 的无症状 PLWH 中检测到 sCAD 的高患病率；CACs 是一种高效的生物标志物，可检测所有严重程度的 sCAD，但颈动脉/股动脉斑块的数量结合也是一种非常有前途的替代标志物，成本更低且无辐射。未来需要更大的研究来验证这些结果。
