title: Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis.
abstract: OBJECTIVE
  Cytokines released by epicardial fat are implicated in the pathogenesis of atherosclerosis. HIV infection and antiretroviral therapy have been associated with changes in body fat distribution and coronary artery disease. We sought to determine whether HIV infection is associated with greater epicardial fat and whether epicardial fat is associated with subclinical coronary atherosclerosis.
  
  
  METHODS
  We studied 579 HIV-infected and 353 HIV-uninfected men aged 40-70 years with noncontrast computed tomography to measure epicardial adipose tissue (EAT) volume and coronary artery calcium (CAC). Total plaque score (TPS) and plaque subtypes (noncalcified, calcified, and mixed) were measured by coronary computed tomography angiography in 706 men.
  
  
  METHODS
  We evaluated the association between EAT and HIV serostatus, and the association of EAT with subclinical atherosclerosis, adjusting for age, race, and serostatus and with additional cardiovascular risk factors and tested for modifying effects of HIV serostatus.
  
  
  RESULTS
  HIV-infected men had greater EAT than HIV-uninfected men (P=0.001). EAT was positively associated with duration of antiretroviral therapy (P=0.02), specifically azidothymidine (P<0.05). EAT was associated with presence of any coronary artery plaque (P=0.006) and noncalcified plaque (P=0.001), adjusting for age, race, serostatus, and cardiovascular risk factors. Among men with CAC, EAT was associated with CAC extent (P=0.006). HIV serostatus did not modify associations between EAT and either CAC extent or presence of plaque.
  
  
  CONCLUSIONS
  Greater epicardial fat volume in HIV-infected men and its association with coronary plaque and antiretroviral therapy duration suggest potential mechanisms that might lead to increased risk for cardiovascular disease in HIV.
authors.affiliation: aJohns Hopkins University School of Medicine, Baltimore, Maryland bLos Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California cJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland dNorthwestern University, Chicago, Illinois eUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USA. *Michael Brener and Kerunne Ketlogetswe contributed equally to this work.
authors.forename: Michael
authors.initials: M
authors.lastname: Brener
authors.forename: Kerunne
authors.initials: K
authors.lastname: Ketlogetswe
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
authors.forename: Xiuhong
authors.initials: X
authors.lastname: Li
authors.forename: Panteha
authors.initials: P
authors.lastname: Rezaeian
authors.forename: Aryabod
authors.initials: A
authors.lastname: Razipour
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Palella
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kingsley
authors.forename: Mallory D
authors.initials: MD
authors.lastname: Witt
authors.forename: Richard T
authors.initials: RT
authors.lastname: George
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D000368:Aged; D000792:Angiography; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002118:Calcium / Q000032:analysis; D003324:Coronary Artery Disease / Q000453:epidemiology*; D003331:Coronary Vessels / Q000473:pathology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000473:pathology*; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D002118:Calcium