Coronary and peripheral endothelial function in HIV patients studied with positron emission tomography and flow-mediated dilation: relation to hypercholesterolemia.
BACKGROUND
The mechanisms underlying increased cardiovascular risk in HIV patients in antiretroviral therapy (ART) are not known. Our aim was to study the endothelial function of the coronary arteries by cardiac perfusion positron emission tomography (PET), in HIV patients with normal or high cholesterol levels. Flow mediated dilation (FMD) of the brachial artery and circulating endothelial markers were also assessed.


RESULTS
HIV patients in ART with total cholesterol <or= 5.5 mmol/L (215 mg/dL; n = 13) or total cholesterol >or= 6.5 mmol/L (254 mg/dL; n = 12) and healthy controls (n = 14) were included. (13)NH(3) perfusion PET, FMD, and measurement of plasma levels of E-Selectin, ICAM-1, VCAM-1, tPAI-1, and hs-CRP were performed. Baseline myocardial perfusion and the coronary flow reserve measured by PET (3.2 +/- 0.3, 3.2 +/- 0.3 and 3.0 +/- 0.3; ns) was similar in HIV patients with normal or high total cholesterol and controls. FMD did not differ between the groups and was 4.6 +/- 1.1%, 5.1 +/- 1.2%, and 4.6 +/- 0.8%, respectively. Increased levels of plasma E-Selectin, ICAM-1, tPAI-1, and hs-CRP were found in HIV patients when compared to controls (p < 0.05). E-Selectin and ICAM-1 levels were higher in HIV patients receiving protease inhibitors (PI) compared to those not receiving PI (p < 0.05). None of the measured endothelial biomarkers differed between the normal and high cholesterol HIV groups.


CONCLUSIONS
In ART-treated HIV patients with a low overall cardiovascular risk, no sign of endothelial dysfunction was found not even in hypercholesterolemic patients. Also, the increased level of plasma endothelial markers found in HIV patients was not related to hypercholesterolemia.
Lebech
Anne-Mette
AM
Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark. lebech@dadlnet.dk
Kristoffersen
Ulrik Sloth
US
Wiinberg
Niels
N
Kofoed
Kristian
K
Andersen
Ove
O
Hesse
Birger
B
Petersen
Claus Leth
CL
Gerstoft
Jan
J
Kjaer
Andreas
A
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D016022:Case-Control Studies; D002784:Cholesterol / Q000378:metabolism; D003326:Coronary Circulation; D004727:Endothelium / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D015658:HIV Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D006937:Hypercholesterolemia / Q000139:chemically induced* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000166:cytology*; D049268:Positron-Emission Tomography; D012306:Risk; D014463:Ultrasonography; D014666:Vasomotor System / Q000503:physiopathology
D000998:Antiviral Agents; D015415:Biomarkers; D002784:Cholesterol