Elevated osteoprotegerin is associated with abnormal ankle brachial indices in patients infected with HIV: a cross‐sectional study

James J Jang,Mark Woodward,Jeffrey W Olin,Daniel A Amaez,Aron I Schwarcz,Alison D Schecter,Marla J Keller

doi:10.1186/1758-2652-13-12

Abstract

BackgroundPatients infected with HIV have an increased risk for accelerated atherosclerosis. Elevated levels of osteoprotegerin, an inflammatory cytokine receptor, have been associated with a high incidence of cardiovascular disease (including peripheral arterial disease, or PAD), acute coronary syndrome, and cardiovascular mortality. The objective of this study was to determine whether PAD is prevalent in an HIV-infected population, and to identify an association with HIV-specific and traditional cardiovascular risk factors, as well as levels of osteoprotegerin.MethodsOne hundred and two patients infected with HIV were recruited in a cross-sectional study. To identify the prevalence of PAD, ankle-brachial indices (ABIs) were measured. Four standard ABI categories were utilized: ≤ 0.90 (definite PAD); 0.91-0.99 (borderline); 1.00-1.30 (normal); and >1.30 (high). Medical history and laboratory measurements were obtained to determine possible risk factors associated with PAD in HIV-infected patients.ResultsThe prevalence of PAD (ABI ≤ 0.90) in a young HIV-infected population (mean age: 48 years) was 11%. Traditional cardiovascular risk factors, including advanced age and previous cardiovascular history, as well as elevated C-reactive protein levels, were associated with PAD. Compared with patients with normal ABIs, patients with high ABIs had significantly elevated levels of osteoprotegerin [1428.9 (713.1) pg/ml vs. 3088.6 (3565.9) pg/ml, respectively, p = 0.03].ConclusionsThere is a high prevalence of PAD in young HIV-infected patients. A number of traditional cardiovascular risk factors and increased osteoprotegerin concentrations are associated with abnormal ABIs. Thus, early screening and aggressive medical management for PAD may be warranted in HIV-infected patients.

Highlights

Patients infected with HIV have an increased risk for accelerated atherosclerosis
Risk factors for peripheral arterial disease (PAD) associated with HIV infection Potential HIV-specific risk factors, including duration of protease inhibitor use, HIV exposure duration, CD4 count and viral load, were evaluated
None of these risk factors were found to be independently predictive of abnormal ankle-brachial indices (ABIs) in this cohort

Summary

Introduction

Patients infected with HIV have an increased risk for accelerated atherosclerosis. The objective of this study was to determine whether PAD is prevalent in an HIV-infected population, and to identify an association with HIV-specific and traditional cardiovascular risk factors, as well as levels of osteoprotegerin. There is evidence of accelerated atherosclerosis among young patients infected with HIV [2]. Three recent epidemiologic studies have reported an increased prevalence of peripheral arterial disease (PAD) in HIVinfected patients [3,4,5]. There is a paucity of clinical data on the predictive risk factors and biologic markers associated with PAD in HIV-infected patients. PI use was found to be associated with PAD in HIVinfected patients [9]

Objectives

Methods

Results

Discussion

Conclusion