Kikuchi Daniel S, Kwapong Yaa A, Schär Michael, Weiss Robert G, Sun Kevin, Brown Todd T, Piggott Damani A, Minhas Anum S, Gerstenblith Gary, Soleimani-Fard Alborz, Leucker Thorsten M, Hays Allison G
Internal Medicine, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA.
The Ciccarone Center for the Prevention of Cardiovascular Diseases Johns Hopkins University School of Medicine Baltimore MD USA.
J Am Heart Assoc. 2024 Dec 3;13(23):e035975. doi: 10.1161/JAHA.124.035975. Epub 2024 Nov 22.
HIV-associated cardiovascular disease (CVD) is increasing in prevalence. The mechanisms underlying the heightened cardiovascular risk faced by people with HIV (PWH), however, remain poorly defined. Recent studies indicate an important role of lipoprotein(a) (Lp[a]) in predicting CVD risk in the general population, but little is known regarding its role in HIV-associated CVD. Thus, we sought to evaluate whether Lp(a) is elevated in PWH and if it is associated with impaired coronary endothelial function (CEF), a known mediator of CVD in PWH.
In this cross-sectional study, cardiac magnetic resonance imaging with isometric handgrip exercise, an endothelial dependent stressor, was performed to assess CEF in 65 PWH and 52 controls without HIV. Percent changes in coronary cross-sectional area and coronary blood flow from rest to stress were used to quantify CEF. Lp(a) levels were assessed by immunoturbidimetric assay at the time of magnetic resonance imaging. Lp(a) levels were higher in PWH compared with controls (78 nmol/L [39-137 nmol/L] versus 45.5 nmol/L [18-102.5 nmol/L], <0.01). Both percent change in coronary cross-sectional area (0.38% [-6.1% to 5.4%] versus 7.43% [2.4%-11.2%], <0.0005) and coronary blood flow (9.1% [-1.3% to 23.1%] versus 24.1% [3.3%-39.8%], <0.05) were lower in PWH compared with controls. In PWH, Lp(a) was inversely associated with percent change in coronary cross-sectional area (β=-6.18±1.01%/nmol/L, <0.001) but not with percent change in coronary blood flow even after adjustment for confounding risk factors. No association between Lp(a) and measures of CEF was observed in individuals without HIV.
Lp(a) concentrations are elevated in PWH and inversely related to CEF in PWH.
与HIV相关的心血管疾病（CVD）患病率正在上升。然而，HIV感染者（PWH）面临心血管疾病风险增加的潜在机制仍未明确。最近的研究表明脂蛋白（a）（Lp[a]）在预测普通人群CVD风险中起重要作用，但对于其在与HIV相关的CVD中的作用知之甚少。因此，我们试图评估PWH的Lp（a）水平是否升高，以及它是否与冠状动脉内皮功能（CEF）受损有关，CEF是PWH中已知的CVD介质。
在这项横断面研究中，对65名PWH和52名无HIV的对照者进行了心脏磁共振成像检查，并进行等长握力运动（一种内皮依赖性应激源）以评估CEF。从静息状态到应激状态冠状动脉横截面积和冠状动脉血流的百分比变化用于量化CEF。在磁共振成像时通过免疫比浊法评估Lp（a）水平。与对照组相比，PWH的Lp（a）水平更高（78 nmol/L [39 - 137 nmol/L] 对 45.5 nmol/L [18 - 102.5 nmol/L]，<0.01）。与对照组相比，PWH的冠状动脉横截面积百分比变化（0.38% [-6.1% 至 5.4%] 对 7.43% [2.4% - 11.2%]，<0.0005）和冠状动脉血流百分比变化（9.1% [-1.3% 至 23.1%] 对 24.1% [3.3% - 39.8%]，<0.05）均较低。在PWH中，Lp（a）与冠状动脉横截面积百分比变化呈负相关（β = -6.18 ± 1.01%/nmol/L，<0.001），但即使在调整混杂风险因素后，与冠状动脉血流百分比变化也无相关性。在无HIV的个体中未观察到Lp（a）与CEF测量值之间的关联。
PWH的Lp（a）浓度升高，且与PWH的CEF呈负相关。
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