title: Epicardial adipose tissue and coronary artery calcium predict incident myocardial infarction and death in HIV-infected patients.
abstract: BACKGROUND
  Epicardial adipose tissue (EAT) and coronary artery calcium (CAC) have been associated with incident coronary artery disease (CAD) and all-cause mortality in the general population. Their prognostic impact in HIV is unknown.
  
  
  METHODS
  Observational study of 843 consecutive HIV-infected patients receiving antiretroviral therapy for at least 6 months. Risk stratification was performed with coronary artery calcium (CAC) scoring and EAT screening. Patients were followed for CAD and all-cause mortality for a median of 2.8 years accounting for a total of 2572 patient-year follow-up.
  
  
  RESULTS
  Mean patient age was 50 ± 8 years and 69% were men. At baseline EAT was associated with male gender, age, waist circumference, visceral adipose tissue, and lipodystrophy, while CAC score ≥ 100 was associated with male gender, age and total cholesterol. During follow-up 33 patients suffered an event (15 incident myocardial infarctions and 18 deaths); the EAT volume was larger and the CAC score was higher in patients with events (p = 0.038 and p = 0.001 respectively). Multivariable regression analyses demonstrated that the upper tertile of EAT (≥ 93 cc; OR 2.15, 95% CI 1.06 - 4.39, p = 0.034), and CAC score ≥ 100 (OR 3.37, 95% CI 1.49 - 7.60, p = 0.003) were independent predictors of events after adjusting for age and sex.
  
  
  CONCLUSIONS
  In this observational cohort of HIV patients, EAT and CAC were independent predictors of hard outcomes after a median follow-up of approximately 3 years.
authors: Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, AB, Canada. Electronic address: aggi@ualberta.ca.
authors: Paolo
authors: P
authors: Raggi
authors: Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
authors: Stefano
authors: S
authors: Zona
authors: Radiology Unit, Department of Imaging, University of Modena and Reggio Emilia, Modena, Italy.
authors: Riccardo
authors: R
authors: Scaglioni
authors: Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
authors: Chiara
authors: C
authors: Stentarelli
authors: Radiology Unit, Department of Imaging, University of Modena and Reggio Emilia, Modena, Italy.
authors: Guido
authors: G
authors: Ligabue
authors: Radiology Unit, Department of Imaging, University of Modena and Reggio Emilia, Modena, Italy.
authors: Giulia
authors: G
authors: Besutti
authors: Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
authors: Marianna
authors: M
authors: Menozzi
authors: Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
authors: Antonella
authors: A
authors: Santoro
authors: Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
authors: Andrea
authors: A
authors: Malagoli
authors: Azienda Ospedaliera, St. Anna, Como, Italy; Department of Health Sciences, University of Milan, Milan, Italy.
authors: Antonio
authors: A
authors: Bellasi
authors: Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy.
authors: Giovanni
authors: G
authors: Guaraldi
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality*; D016017:Odds Ratio; D010496:Pericardium / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy
chemical_list: D019380:Anti-HIV Agents
keywords: Computed tomography; Coronary artery calcium; Epicardial adipose tissue; HIV infection