BOSTON — The concurrent presence of metabolic syndrome and subclinical atherosclerosis in HIV infection may help identify individuals at increased risk for cardiovascular disease, a study has shown.
The findings, reported by Alexandra Mangili, M.D., in a poster presentation at a conference on retroviruses and opportunistic infections, could be used to guide therapy designed to prevent cardiovascular events in people with AIDS or HIV infection.
In a longitudinal study examining nutritional and metabolic parameters in HIV infection, Dr. Mangili and colleagues at Tufts University in Boston measured common carotid and internal carotid intima-medial thickness (IMT) by B-mode ultrasonography in 327 HIV-infected patients. Coronary calcium score was also measured by high-resolution ECG-synchronized computed tomography.
The investigators compared these parameters in patients with and without signs of metabolic syndrome, defined as the presence of at least three of the following: abdominal obesity, hypertriglyceridemia, low HDL cholesterol, hypertension, and elevated fasting glucose.
After adjustment for sex, age, race, and smoking, individuals with metabolic syndrome had significantly higher common carotid IMT values than did patients without metabolic syndrome. The metabolic syndrome patients were also more likely to have abnormal coronary calcium scores, but not internal carotid IMT values, Dr. Mangili said at the conference, which was sponsored by the Foundation for Retrovirology and Human Health.
CD4 cell counts, viral load values, and use of highly active antiretroviral regimens, protease inhibitors, and nonnucleoside reverse transcriptase inhibitors were similar between patients with and without metabolic syndrome, she noted.
Subclinical carotid and coronary atherosclerosis are independent predictors of adverse cardiac events, and there is increasing evidence that metabolic syndrome is predictive of cardiovascular disease. The association seen in this study population between metabolic syndrome and subclinical atherosclerosis as determined by elevated IMT and coronary calcium adds to the growing body of knowledge linking HIV infection and/or treatment to an increased risk of cardiovascular events, Dr. Mangili noted.
The increased cardiovascular risks for HIV patients with both metabolic syndrome and subclinical atherosclerosis should be considered when planning their treatment, she said.