人类免疫缺陷病毒与亚临床冠状动脉粥样硬化相关：一项前瞻性匹配队列研究。

HIV Is Associated With Subclinical Coronary Atherosclerosis: A Prospective Matched Cohort Study.

作者信息

Knudsen Andreas D, Fuchs Andreas, Benfield Thomas, Køber Lars, Nordestgaard Børge Grønne, Afzal Shoaib, Kuhl Jørgen Tobias, Sigvardsen Per Ejlstrup, Suarez-Zdunek Moises Alberto, Gelpi Marco, Nielsen Susanne D, Kofoed Klaus F

机构信息

Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

出版信息

Clin Infect Dis. 2025 Aug 1;81(1):84-91. doi: 10.1093/cid/ciae609.

DOI:10.1093/cid/ciae609

PMID:40587175

Abstract

BACKGROUND

Persons with HIV (PWH) have an elevated risk of myocardial infarction compared to the general population. However, the underlying mechanisms linking HIV with this increased risk remain unclear. We aimed to compare the prevalence and characteristics of subclinical coronary atherosclerosis in PWH with population controls.

METHODS

Participants were included from the Copenhagen Comorbidity in HIV Infection study and the Copenhagen General Population Study. Presence of any and obstructive subclinical coronary atherosclerosis (≥50% stenosis) were assessed using coronary computed tomography angiography. Analyses were adjusted for cardiovascular risk factors including age, sex, hypertension, dyslipidemia, current smoking, overweight or obesity, and diabetes.

RESULTS

We included 519 PWH and 1114 age and sex-matched population controls. The median age was 52 years, and 89% of participants were men. The cardiovascular risk, evaluated by the Systematic COronary Risk Evaluation 2 prediction algorithm, was similar in PWH and population controls. PWH exhibited a higher prevalence of both any (54% vs 42%, P < .001) and obstructive coronary atherosclerosis (16% vs 8%, P < .001) than population controls. After adjusting for cardiovascular risk factors, HIV was associated with an odds ratio of 1.98 [95% confidence interval, 1.52-2.58] of any coronary atherosclerosis, and odds ratio of 3.21 [2.00-5.17] of obstructive atherosclerosis.

CONCLUSIONS

HIV is independently associated with a three-fold higher risk of subclinical obstructive coronary atherosclerosis. Our results offer a possible explanation for the higher risk of myocardial infarction observed in PWH.

摘要

背景

与普通人群相比，艾滋病毒感染者（PWH）发生心肌梗死的风险更高。然而，将艾滋病毒与这种风险增加联系起来的潜在机制仍不清楚。我们旨在比较PWH与人群对照中亚临床冠状动脉粥样硬化的患病率和特征。

方法

参与者来自哥本哈根艾滋病毒感染合并症研究和哥本哈根普通人群研究。使用冠状动脉计算机断层扫描血管造影评估是否存在任何亚临床冠状动脉粥样硬化和阻塞性亚临床冠状动脉粥样硬化（狭窄≥50%）。分析针对心血管危险因素进行了调整，包括年龄、性别、高血压、血脂异常、当前吸烟、超重或肥胖以及糖尿病。

结果

我们纳入了519名PWH和1114名年龄和性别匹配的人群对照。中位年龄为52岁，89%的参与者为男性。通过系统性冠状动脉风险评估2预测算法评估的心血管风险在PWH和人群对照中相似。与人群对照相比，PWH中任何亚临床冠状动脉粥样硬化（54%对42%，P <.001）和阻塞性冠状动脉粥样硬化（16%对8%，P <.001）的患病率均更高。在调整心血管危险因素后，艾滋病毒与任何冠状动脉粥样硬化的比值比为1.98[95%置信区间，1.52 - 2.58]，与阻塞性动脉粥样硬化的比值比为3.21[2.00 - 5.17]。