Abstract 18073: Traditional Lipid and Advanced Lipoprotein Associations With Subclinical Atherosclerosis of Persons Living With and Without HIV: The Multicenter AIDS Cohort Study (MACS)

Abstract

Background: HIV infection is associated with coronary artery disease (CAD). We previously observed that HIV-infected (HIV+) men had a higher prevalence of non-calcified plaque than uninfected (HIV-) men. We tested associations between lipids and plaque composition and differences by HIV status. Methods: We performed non-contrast (n=613) and contrast coronary (n= 464) CT scans to measure coronary calcium (CAC), total plaque (TP), non-calcified plaque (NCP), calcified plaque (CP), mixed plaque (MP) and stenosis greater than 50%. Traditional lipid and advanced lipoprotein measures with nuclear magnetic resonance (NMR) were determined using blood samples in HIV+ and HIV- men who have sex with men (MSM) age 40-70 years. Separate logistic regression models were used to estimate associations between presence of plaque and each lipid variable, adjusting for age, race, CAD risk factors, and use of cholesterol medications. Effect modification by HIV was tested with interaction terms. Results: HIV+ men had lower LDL particle concentrations (LDL-p), but higher small LDL-p and smaller LDL-p size. HIV+ men had higher medium HDL-p and lower total, large and small HDL-p and traditional HDL concentrations. They had higher total and large VLDL-chylomicron (CHY), medium VLDL, VLDL particle size, NMR VLDL-CHY-TG concentrations and higher traditional TG (p<0.05). Increased LDL-p and small LDL-p were both associated with the presence of CAC, any plaque (TP), NCP, CP, and MP (all p< 0.03; OR per SD 1.27- 1.41). Large HDL-p and HDL were inversely associated with presence of TP, NCP and MP (all p<0.05; OR per SD 0.67-0.79). Increased VLDL-CHY, small VLDL-p, small LDL-p and traditional TG were associated with stenosis greater than 50% (all p<0.02; OR per SD 1.49-1.57). Cholesterol medication use was positively associated with presence of CAC, TPS, MP, and CP, but not NCP. There were no significant interactions by HIV status for these outcomes. Conclusions: Most plaque subtypes are associated with LDL and HDL particles. Cholesterol medication use is associated with calcified plaque but not NCP. VLDL and TG particles were associated with stenosis > 50%. HIV+ men have higher concentrations of atherogenic lipid particles than HIV- men, which may explain some of the increased risk for CAD.