title: Mitral Annular and Coronary Artery Calcification Are Associated with Mortality in HIV-Infected Individuals.
abstract: BACKGROUND
  HIV infection increases cardiovascular risk. Coronary artery calcification (CAC) and mitral annular calcification (MAC) identify patients at risk for cardiovascular disease (CVD). The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals.
  
  
  RESULTS
  We studied 152 asymptomatic HIV-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT). MAC was identified on TTE using standardized criteria. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the Social Security and National Death Indices (SSDI/NDI). The median age was 49 years; 87% were male. The median duration of HIV was 16 years; 84% took antiretroviral therapy; 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Twenty-five percent of individuals had MAC, and 42% had CAC. Over a median follow-up of 8 years, 11 subjects died. Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC. The Harrell's C-statistic of CAC was 0.66 and increased to 0.75 when MAC was added (p = 0.05). MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all).
  
  
  CONCLUSIONS
  In HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC. Presence of CAC and MAC may be useful in identifying HIV-infected individuals at higher risk for death.
authors.affiliation: Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
authors.forename: David C
authors.initials: DC
authors.lastname: Lange
authors.affiliation: Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Glidden
authors.affiliation: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Secemsky
authors.affiliation: Department of Radiology, University of California, San Francisco, San Francisco, California, United States of America.
authors.forename: Karen
authors.initials: K
authors.lastname: Ordovas
authors.affiliation: Division of HIV/AIDS Positive Health Program, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, United States of America.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Deeks
authors.affiliation: Department of Epidemiology and Biostatistics, San Francisco General Hospital, University of California, San Francisco, California, United States of America.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Martin
authors.affiliation: Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California, United States of America.
authors.forename: Ann F
authors.initials: AF
authors.lastname: Bolger
authors.affiliation: Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California, United States of America.
authors.forename: Priscilla Y
authors.initials: PY
authors.lastname: Hsue
mesh_terms: D000328:Adult; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D061205:Vascular Calcification / Q000150:complications / Q000453:epidemiology* / Q000401:mortality