Lipinski Jerry, Margevicius Seunghee, Schluchter Mark D, Wilson David L, McComsey Grace A, Longenecker Chris T
Department of Internal Medicine, University of California, San Diego, San Diego, CA, USA.
School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Antivir Ther. 2020;25(8):419-427. doi: 10.3851/IMP3389.
Inflammation has been associated with whole heart coronary artery calcification (CAC) among people with HIV (PWH) on antiretroviral therapy (ART); however, prior studies have not evaluated the distribution of calcium or separated mass versus volume scores, which are differentially associated with clinical events in the general population. Statins may also have a greater effect on CAC mass compared with volume.
147 PWH were randomized 1:1 to rosuvastatin 10 mg or placebo and followed for 96 weeks. We re-analysed coronary calcium scans from 0, 48 and 96 weeks to determine mass and volume scores and measures of CAC diffusivity. Mixed effects models and generalized estimating equations were used to examine longitudinal associations of CAC with treatment and biomarkers.
Median age at study entry was 46 years; 78% were male and 68% African American. Median CD4+ was 613 and half were on protease inhibitors. Randomization to statin therapy was not associated with a change in mass score, volume score, number of involved vessels or diffusivity index (all P>0.1). Soluble CD14 was associated with the presence of CAC (P=0.05) and borderline associated with number of involved vessels (P=0.07) across all three time points.
In PWH on ART, moderate intensity rosuvastatin does not appear to have a significant effect on volume, mass or regional distribution of CAC over 96 weeks. We extend previous cross-sectional observations to show that soluble CD14 is associated with whole heart CAC over time and independently of age and systolic blood pressure.
在接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PWH）中，炎症与全心冠状动脉钙化（CAC）有关；然而，先前的研究尚未评估钙的分布情况，也未区分质量评分与体积评分，而在普通人群中，这两种评分与临床事件的关联有所不同。与体积相比，他汀类药物对CAC质量的影响可能更大。
147名PWH按1:1随机分为瑞舒伐他汀10毫克组或安慰剂组，并随访96周。我们重新分析了0周、48周和96周时的冠状动脉钙化扫描结果，以确定质量评分、体积评分和CAC扩散率测量值。采用混合效应模型和广义估计方程来检验CAC与治疗及生物标志物之间的纵向关联。
研究入组时的中位年龄为46岁；78%为男性，68%为非裔美国人。中位CD4 + 细胞计数为613，一半患者使用蛋白酶抑制剂。随机接受他汀类药物治疗与质量评分、体积评分、受累血管数量或扩散率指数的变化均无关联（所有P>0.1）。在所有三个时间点，可溶性CD14与CAC的存在相关（P = 0.05），与受累血管数量的关联接近显著（P = 0.07）。
在接受ART的PWH中，中等强度的瑞舒伐他汀在96周内似乎对CAC的体积、质量或区域分布没有显著影响。我们扩展了先前的横断面观察结果，表明可溶性CD14随时间推移与全心CAC相关，且独立于年龄和收缩压。
