title: Increased coronary atherosclerotic plaque vulnerability by coronary computed tomography angiography in HIV-infected men.
abstract: OBJECTIVE
  Among HIV-infected patients, high rates of myocardial infarction (MI) and sudden cardiac death have been observed. Exploring potential underlying mechanisms, we used multidetector spiral coronary computed tomography angiography (coronary CTA) to compare atherosclerotic plaque morphology in HIV-infected patients and non-HIV-infected controls.
  
  
  METHODS
  Coronary atherosclerotic plaques visualized by CTA in HIV-infected (101) and non-HIV-infected (41) men without clinically apparent heart disease matched on cardiovascular risk factors were analyzed for three vulnerability features: low attenuation, positive remodeling, and spotty calcification.
  
  
  RESULTS
  Ninety-five percent of HIV-infected patients were receiving ART (median duration 7.9 years) and had well controlled disease (median CD4 cell count, 473 cells/μl; median HIV RNA <50 copies/ml). Age and traditional cardiovascular risk factors were similar in HIV-infected patients and controls. Among the HIV-infected (versus control) group, there was a higher prevalence of patients with at least one: low attenuation plaque (22.8 versus 7.3%, P = 0.02), positively remodeled plaque (49.5 versus 31.7%, P = 0.05) and high-risk 3-feature plaque (7.9 versus 0%, P = 0.02). Moreover, patients in the HIV-infected (versus control) group demonstrated a higher number of low attenuation plaques (P = 0.01) and positively remodeled plaques (P = 0.03) per patient.
  
  
  CONCLUSIONS
  Our data demonstrate an increased prevalence of vulnerable plaque features among relatively young HIV-infected patients. Differences in coronary atherosclerotic plaque morphology - namely, increased vulnerable plaque among HIV-infected patients - are here for the first time reported and may contribute to increased rates of MI and sudden cardiac death in this population.
authors: Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. mzanni@partners.org
authors: Markella V
authors: MV
authors: Zanni
authors: Suhny
authors: S
authors: Abbara
authors: Janet
authors: J
authors: Lo
authors: Bryan
authors: B
authors: Wai
authors: David
authors: D
authors: Hark
authors: Eleni
authors: E
authors: Marmarelis
authors: Steven K
authors: SK
authors: Grinspoon
mesh_terms: D000293:Adolescent; D000328:Adult; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology*; D003331:Coronary Vessels / Q000473:pathology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000209:etiology*; D011237:Predictive Value of Tests; D012307:Risk Factors; D036542:Tomography, Spiral Computed / Q000379:methods; D055815:Young Adult