title: HIV infection and progression of carotid and coronary atherosclerosis: the CARE study.
abstract: BACKGROUND
  Progression of carotid intima-media thickness (c-IMT) and coronary artery calcium (CAC) are increasingly used as surrogates for vascular risk. We assessed the predictors of c-IMT and CAC progression in a large longitudinal cohort of HIV-infected adults.
  
  
  METHODS
  c-IMT, CAC scores, and vascular and HIV risk factors were evaluated at baseline and at 3-year follow-up in 255 HIV-infected adults. Multivariate regression was used to determine the predictors of atherosclerotic progression.
  
  
  RESULTS
  The mean change in c-IMT per year of follow-up was 0.016 mm for the common and 0.020 mm for the internal. Significant predictors of yearly progression were age, systolic blood pressure, triglycerides, and insulin for common c-IMT and triglycerides >=150 mg/dL, glucose >126 mg/dL, use of glucose-lowering medications, quantitative insulin sensitivity check index, high waist circumference, and current smoking for internal c-IMT. Twenty-eight percent had CAC progression. Of those with zero CAC at baseline, 32% had detectable scores at follow-up. Of those with detectable CAC at baseline, 26% had progression at follow-up. For CAC score, quantitative insulin sensitivity check index, apolipoprotein B, and triglycerides predicted progression. Those with abnormal surrogate markers at baseline were more likely to have the metabolic syndrome reversed and be started on antihypertensive medications over the 3-year follow-up period than those who had no abnormalities at baseline.
  
  
  CONCLUSIONS
  Although c-IMT and CAC progression rates in HIV-infected patients appear higher than expected for this age and risk groups, traditional cardiovascular risk factors remain the strongest determinants of carotid and coronary atherosclerotic disease progression in HIV-infected patients. Aggressive cardiovascular risk reduction is effective at slowing the atherosclerotic progression in those with preexisting disease.
authors.affiliation: Nutrition/Infection Unit, Department of Public Health and Community Medicine, Tufts University School of Medicine, Tufts Medical Center, 150 Harrison Avenue, Boston, MA 02111, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Mangili
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.forename: Sally C
authors.initials: SC
authors.lastname: Skinner
authors.forename: Jul
authors.initials: J
authors.lastname: Gerrior
authors.forename: Heidi
authors.initials: H
authors.lastname: Sheehan
authors.forename: Anita
authors.initials: A
authors.lastname: Harrington
authors.forename: Christine A
authors.initials: CA
authors.lastname: Wanke
mesh_terms: D000328:Adult; D002114:Calcinosis; D002340:Carotid Artery Diseases / Q000097:blood / Q000150:complications* / Q000473:pathology*; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography