title: Comparison of Insulin Resistance to Coronary Atherosclerosis in Human Immunodeficiency Virus Infected and Uninfected Men (from the Multicenter AIDS Cohort Study).
abstract: The relation between insulin resistance (IR) and coronary artery disease in patients with human immunodeficiency virus (HIV) infection remains incompletely defined. Fasting serum insulin and glucose measurements from 448 HIV-infected and 306 uninfected men enrolled in the Multicenter AIDS Cohort Study were collected at semiannual visits from 2003 to 2013 and used to compute the homeostatic model assessment of IR (HOMA-IR). Coronary computed tomographic angiography (CTA) was performed at the end of the study period to characterize coronary pathology. Associations between HOMA-IR (categorized into tertiles and assessed near the time of the CTA and over the 10-year study period) and the prevalence of coronary plaque or stenosis ≥50% were assessed with multivariate logistic regression. HOMA-IR was higher in HIV-infected men than HIV-uninfected men when measured near the time of CTA (3.2 vs 2.7, p = 0.002) and when averaged over the study period (3.4 vs 3.0, p <0.001). The prevalence of coronary stenosis ≥50% was similar between both groups (17% vs 15%, p = 0.41). Both measurements of HOMA-IR were associated with greater odds of coronary stenosis ≥50% in models comparing men with values in the highest versus the lowest tertiles, although the effect of mean HOMA-IR was stronger than the single measurement of HOMA-IR before CTA (odds ratio 2.46, 95% CI 1.95 to 3.11, vs odds ratio 1.43, 1.20 to 1.70). This effect was not significantly modified by HIV serostatus. In conclusion, IR over nearly a decade was greater in HIV-infected men than HIV-uninfected men, and in both groups, was associated with significant coronary artery stenosis.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: michael.brener@jhmi.edu.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Brener
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Haberlen
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Long
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Palella
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Jacobson
authors.affiliation: Department of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Adrian S
authors.initials: AS
authors.lastname: Dobs
authors.affiliation: Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Richard T
authors.initials: RT
authors.lastname: George
authors.affiliation: Los Angeles Biomedical Research Institute, Harbor-University of California-Los Angeles Medical Center, Los Angeles, California.
authors.forename: Mallory D
authors.initials: MD
authors.lastname: Witt
authors.affiliation: Los Angeles Biomedical Research Institute, Harbor-University of California-Los Angeles Medical Center, Los Angeles, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Kingsley
authors.affiliation: Department of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Todd T
authors.initials: TT
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D023921:Coronary Stenosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin
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