Carotid intima media thickness is associated with body fat abnormalities in HIV-infected patients.

Paula Freitas,Davide Carvalho,António Sarmento,Esteban Martinez,José Luís Medina,Ana Cristina Santos,Jorge Pereira,António José Madureira

doi:10.1186/1471-2334-14-348

Paula Freitas, Davide Carvalho + Show 6 more

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https://doi.org/10.1186/1471-2334-14-348

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Abstract

BackgroundHIV-infected patients may be at increased risk of cardiovascular (CV) events, and lipodystrophy is generally associated with proatherogenic metabolic disturbances. Carotid intima-media thickness (cIMT) has been used as a surrogate marker for atherosclerosis and it has been shown to be an independent risk factor for CV disease. Our objective was to evaluate cIMT in HIV-infected patients on combined anti-retroviral therapy (cART) with and without lipodystrophy defined by fat mass ratio (L-FMR), and to determine the association of lipodystrophy and visceral obesity [(visceral (VAT), subcutaneous adipose tissue (SAT) volume and VAT/SAT ratio, objectively evaluated by CT scan] with cIMT.MethodsCross-sectional study of 199 HIV-infected patients. Body composition by DXA and abdominal CT, lipids, blood pressure, inflammatory markers, and cIMT by ultrasonography were performed. L-FMR was defined as the ratio of the percentage of trunk fat mass to the percentage of lower limb fat mass by DXA. Categorical variables were compared using the chi-square or Fisher’s exact test. Spearman correlation coefficients were estimated to study the association between cIMT and clinical and metabolic characteristics. Means of cIMT, adjusted for age, were calculated, using generalized linear models.ResultsL-FMR was present in 41.2% of patients and cIMT was higher in these patients [0.81 (0.24) vs. 0.76 (0.25); p = 0.037)]. Lipodystrophic patients had higher VAT and VAT/SAT ratio and lower SAT. cIMT was associated with lipodystrophy evaluated by FMR, trunk fat, total abdominal fat, VAT and VAT/SAT ratio. No association was observed between cIMT and leg fat mass. Using generalized linear models, cIMT means were adjusted for age and no significant differences remained after this adjustment. The adjusted mean of cIMT was 0.787 (95% CI: 0.751-0.823) in patients without lipodystrophy, and 0.775 (95% CI: 0.732-0.817) in those with lipodystrophy (p = 0.671).ConclusionsHIV-infected patients on cART with lipodystrophy defined by FMR, had a significantly higher cIMT. Carotid IMT was also associated with classical cardiovascular risk factors. In these patients, visceral adipose tissue had a significant impact on cIMT, although age was the strongest associated factor.

Highlights

HIV-infected patients may be at increased risk of cardiovascular (CV) events, and lipodystrophy is generally associated with proatherogenic metabolic disturbances
CIMT means were adjusted for age, and no significant differences remained after this adjustment when patients with, and without, lipodystrophy were compared
We found that cIMT was positively correlated with waist/hip ratio, neck circumference, and trunk fat mass evaluated by dualenergy X-ray absorptiometry (DXA) and visceral obesity defined by total abdominal fat, VAT and VAT/SAT ratio by computed tomography (CT) scan

Summary

Introduction

HIV-infected patients may be at increased risk of cardiovascular (CV) events, and lipodystrophy is generally associated with proatherogenic metabolic disturbances. The use of noninvasive surrogate markers of atherosclerosis may improve the prognostic stratification of HIV-infected patients with cardiovascular risk factors, and clarify some of the pending issues related to this disease in HIV infection. Higher rates of sub-clinical atherosclerosis are seen in HIV-1-infected patients, and, controversially, these are usually attributed to classic cardiovascular risk factors and to the side effects of cART [3,4,5]. The disease can cause alterations in several metabolic pathways, such as lipid and glucose metabolism, lipodystrophic patients, per se, may be at a higher risk of atherosclerosis, as fat redistribution is associated with the presence of several known metabolic risk factors for cardiovascular diseases [6]. Patients with clinical lipodystrophy have a significantly higher risk of coronary heart disease at 10 years, measured by the Framingham risk score, than patients without clinical lipodystrophy and those with clinical lipodystrophy and metabolic syndrome were more often classified in moderate and high risk categories, than those without metabolic syndrome [7]

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