J Cardiovasc Comput Tomogr. 2015 Nov-Dec;9(6):553-8. doi: 10.1016/j.jcct.2015.08.002. Epub 2015 Aug 15.
Raggi P1, Zona S2, Scaglioni R3, Stentarelli C2, Ligabue G3, Besutti G3, Menozzi M2, Santoro A2, Malagoli A2, Bellasi A4, Guaraldi G2.
BACKGROUND: Epicardial adipose tissue (EAT) and coronary artery calcium (CAC) have been associated with incident coronary artery disease (CAD) and all-cause mortality in the general population. Their prognostic impact in HIV is unknown.
METHODS: Observational study of 843 consecutive HIV-infected patients receiving antiretroviral therapy for at least 6 months. Risk stratification was performed with coronary artery calcium (CAC) scoring and EAT screening. Patients were followed for CAD and all-cause mortality for a median of 2.8 years accounting for a total of 2572 patient-year follow-up.
RESULTS: Mean patient age was 50 ± 8 years and 69% were men. At baseline EAT was associated with male gender, age, waist circumference, visceral adipose tissue, and lipodystrophy, while CAC score ≥100 was associated with male gender, age and total cholesterol. During follow-up 33 patients suffered an event (15 incident myocardial infarctions and 18 deaths); the EAT volume was larger and the CAC score was higher in patients with events (p = 0.038 and p = 0.001 respectively). Multivariable regression analyses demonstrated that the upper tertile of EAT (≥93 cc; OR 2.15, 95% CI 1.06 - 4.39, p = 0.034), and CAC score ≥100 (OR 3.37, 95% CI 1.49 - 7.60, p = 0.003) were independent predictors of events after adjusting for age and sex.
CONCLUSIONS: In this observational cohort of HIV patients, EAT and CAC were independent predictors of hard outcomes after a median follow-up of approximately 3 years.