Yonsei Med J.  2013 Jul;54(4):990-998. 10.3349/ymj.2013.54.4.990.

Clinical Factors Associated with Carotid Plaque and Intima-Medial Thickness in HIV-Infected Patients

• Jeong SJ
• Kim HW
• Ku NS
• Han SH
• Kim CO
• Choi JY
• Song YG
• Kim JM

• KMID: 2158236
• DOI: http://doi.org/10.3349/ymj.2013.54.4.990

Abstract

PURPOSE
HIV-infected patients are at increased risk for cardiovascular disease, which may be mediated in part by inflammation. This study aimed to evaluate the risk factors of carotid plaque, and clinical factors associated with carotid atherosclerosis measured by carotid intima-medial thickness (cIMT) in HIV patients.
MATERIALS AND METHODS
Clinical and cardiometabolic factors as well as cIMT were prospectively measured in 145 HIV-infected participants who had received combined antiretroviral therapy for > or =6 months. The mean value of the bilateral average cIMT level was used as Mean-IMT in the analysis, and the greatest value among the measured cIMT levels was used as Max-IMT.
RESULTS
Among 145 patients, 34 (23.4%) had carotid plaque. Multivariate logistic regression analysis revealed three independent risk factors of carotid plaque: old age [odds ratio (OR) 6.16, 95% confidence interval (CI) 1.09-34.88; p=0.040], hypertension (OR 12.62, 95% CI 1.72-92.49; p=0.013) and higher low-density lipoprotein cholesterol (LDL-C) (OR 1.08, 95% CI 1.01-1.16; p=0.039). Levels of estimated glomerular filtration rate were inversely associated with Mean-IMT (r=-0.379, p<0.001) and Max-IMT (r=-0.389, p<0.001). Stepwise multivariate regression analyses revealed that age, total cholesterol and fasting glucose were positively correlated with cIMT, independent of other risk factors.
CONCLUSION
The presence of hypertension, old age and a higher level of LDL-C were independent risk factors of carotid plaque among HIV-infected subjects.

Keyword

Carotid plaque; carotid artery intima-media thickness; atherosclerosis; combined antiretroviral therapy; HIV infection

MeSH Terms

Adult
Age Factors
Blood Glucose/analysis
Carotid Artery Diseases/*etiology/*ultrasonography
Carotid Intima-Media Thickness
Cholesterol, LDL/blood
Female
Glomerular Filtration Rate
HIV Infections/*complications/drug therapy/physiopathology
Humans
Hypertension/complications/physiopathology
Logistic Models
Male
Middle Aged
Odds Ratio
Prospective Studies
Risk Factors
Cholesterol, LDL
Blood Glucose

Figure

• 

  Fig. 1 ROC curves for Max-IMT and Mean-IMT for the prediction of carotid artery plaque. The area under the ROC curves for Mean-IMT and Max-IMT were 0.74 (95% CI 0.65-0.84, p<0.001) and 0.76 (95% CI 0.67-0.85, p<0.001), respectively. CI, confidence interval; IMT, intima-media thickness; ROC, receiver operating characteristic.

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