BACKGROUND The incidence of acute coronary events is increased among people living with HIV (PLWH) but there is no risk estimation score, nor a surrogate biomarker able to predict subclinical… Click to show full abstract
BACKGROUND The incidence of acute coronary events is increased among people living with HIV (PLWH) but there is no risk estimation score, nor a surrogate biomarker able to predict subclinical coronary artery disease (sCAD). We assessed the performance of: (i) Framingham risk score (FRMs), (ii) peripheral (carotid and femoral) artery atheromatosis, and (iii) coronary artery calcification score (CACs), to detect the presence of sCAD, in PLWH. METHODS In a cohort of PLWH free of CVD, we measured sCAD and CACs by computed tomography, calculated FRMs and assessed carotid/femoral plaques by ultrasound. RESULTS In 56 participants (age: 49± 10 years, men: 88%, FRMs: 7.2 ± 6.9; mean number of carotid/femoral plaques: 1.4±1.5; CACs>0 present in 59%, median CACs 0.9[(IQR 0-22]): (i) minimal sCAD (stenosis 1-24%; present in 30%) and mild sCAD (25-49%, 25%) were effectively detected by FRMs, number of plaques and CACs (AUC of CACs was better than that of both FRM and plaques, p<0.05); (ii) moderate sCAD (stenosis 50-69%; present in 8.9%) was detected by number of plaques and CACs, but similar AUC (0.969 vs 0.867, respectively, p=NS); (iii) severe sCAD (70-99%, present in only 3 [5.4%]) was detected only by CACs. CONCLUSIONS A high prevalence of sCAD in asymptomatic PLWH free of CVD was detected; CACs is a highly efficient biomarker to detect all grades of sCAD, however, the number of carotid/femoral plaques combined is also a very promising - lower cost and radiation free - surrogate biomarker. Future, larger studies are needed to verify these results.
               
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