Suzuki Takahiro, Haberlen Sabina, Peterson Tess E, Palella Frank, Budoff Matthew J, Witt Mallory D, Magnani Jared W, Post Wendy S
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Atherosclerosis. 2025 May;404:119181. doi: 10.1016/j.atherosclerosis.2025.119181. Epub 2025 Apr 2.
People with HIV (PWH) have greater risk of subclinical cardiovascular disease than people without HIV, but few studies have evaluated risk for mortality based on coronary artery calcium (CAC) among PWH. We aimed to determine the association between CAC and all-cause mortality among men with (MWH) and without HIV (MWOH) and if it differs by HIV serostatus.
We performed a longitudinal analysis in the Multicenter AIDS Cohort Study. We included men who underwent non-contrast cardiac computed tomography. Cox regression analyses were used to examine the associations between CAC presence (Agatston score>0), and with extent of CAC (log (CAC+1)), and subsequent mortality to calculate adjusted hazard ratios [aHR]. We evaluated differences by HIV serostatus using multiplicative CAC × HIV interaction terms.
Among 1344 men (mean age 50 years, CAC prevalence 45.7 %, 821 [61.1 %] MWH), we observed 108 deaths (13.2 %) among MWH and 43 deaths (8.2 %) among MWOH during follow-up (median:13.4 years). CAC presence was positively associated with mortality among all participants (aHR:1.46, 95 %CI:1.02-2.10, p = 0.04) and MWH (aHR:1.62, 1.05-2.49, p = 0.03). Among MWOH, we found no significant association (aHR:1.28, 0.63-2.58, p = 0.50). The extent of CAC was associated with mortality among all participants (aHR:1.37 per SD, 1.15-1.63, p < 0.001) and MWH (aHR:1.41,1.14-1.74, p = 0.002). Among MWOH, we found no significant association (aHR:1.35, 0.98-1.85, p = 0.07). There were no significant interactions by HIV serostatus for mortality for either the presence (p = 0.35) or extent of CAC (p = 0.51).
CAC was positively associated with mortality in a large cohort of MWH, and the overall cohort including MWH and MWOH.
与未感染艾滋病毒的人相比，感染艾滋病毒的人（PWH）患亚临床心血管疾病的风险更高，但很少有研究评估PWH中基于冠状动脉钙化（CAC）的死亡风险。我们旨在确定有（MWH）和无艾滋病毒（MWOH）男性中CAC与全因死亡率之间的关联，以及这种关联是否因艾滋病毒血清学状态而异。
我们在多中心艾滋病队列研究中进行了纵向分析。纳入接受非增强心脏计算机断层扫描的男性。采用Cox回归分析来检验CAC存在（阿加斯顿评分>0）以及CAC程度（log（CAC + 1））与随后死亡率之间的关联，以计算调整后的风险比[aHR]。我们使用乘法CAC×艾滋病毒交互项评估艾滋病毒血清学状态的差异。
在1344名男性（平均年龄50岁，CAC患病率45.7%，821名[61.1%]为MWH）中，我们观察到随访期间MWH中有108例死亡（13.2%），MWOH中有43例死亡（8.2%）（中位数：13.4年）。在所有参与者（aHR：1.46，95%CI：1.02 - 2.10，p = 0.04）和MWH（aHR：1.62，1.05 - 2.49，p = 0.03）中，CAC存在与死亡率呈正相关。在MWOH中，我们未发现显著关联（aHR：1.28，0.63 - 2.58，p = 0.50）。CAC程度与所有参与者（aHR：每标准差1.37，1.15 - 1.63，p < 0.001）和MWH（aHR：1.41，1.14 - 1.74，p = 0.002）的死亡率相关。在MWOH中，我们未发现显著关联（aHR：1.35，0.98 - 1.85，p = 0.07）。对于CAC存在（p = 0.35）或程度（p = 0.51），艾滋病毒血清学状态与死亡率均无显著交互作用。
在一大群MWH以及包括MWH和MWOH的整个队列中，CAC与死亡率呈正相关。
