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Sex Differences in Subclinical Coronary Atherosclerotic Plaque Among Individuals with HIV on Antiretroviral Therapy.

Sex Differences in Subclinical Coronary Atherosclerotic Plaque Among Individuals with HIV on Antiretroviral Therapy.
Author Information (click to view)

Foldyna B, Fourman LT, Lu MT, Mueller ME, Szilveszter B, Neilan TG, Ho JE, Burdo TH, Lau ES, Stone LA, Toribio M, Srinivasa S, Looby SE, Lo J, Fitch KV, Zanni MV,


Foldyna B, Fourman LT, Lu MT, Mueller ME, Szilveszter B, Neilan TG, Ho JE, Burdo TH, Lau ES, Stone LA, Toribio M, Srinivasa S, Looby SE, Lo J, Fitch KV, Zanni MV, (click to view)

Foldyna B, Fourman LT, Lu MT, Mueller ME, Szilveszter B, Neilan TG, Ho JE, Burdo TH, Lau ES, Stone LA, Toribio M, Srinivasa S, Looby SE, Lo J, Fitch KV, Zanni MV,

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Journal of acquired immune deficiency syndromes (1999) 2018 03 27() doi 10.1097/QAI.0000000000001686

Abstract
BACKGROUND
In high-resource settings, the HIV-attributable risk of myocardial infarction (MI) is higher among women than among men. The extent to which unique mechanisms contribute to MI risk among women vs. men with HIV remains unclear.

METHODS
Subclinical coronary atherosclerotic plaque characteristics – including high-risk morphology plaque features – were compared among 48 HIV-infected women (48 [41, 54] years) and 97 HIV-infected men (48 [42, 52] years) on stable antiretroviral therapy (ART) without known cardiovascular disease. These individuals had previously completed coronary computed tomography angiography and metabolic/immune phenotyping as part of a prospective study.

RESULTS
Extending prior analyses, now focusing exclusively on ART-treated participants, we found that HIV-infected women had a lower prevalence of any subclinical coronary atherosclerotic plaque (35% vs. 62%, P=0.003) and a lower number of segments with plaque (P=0.01), compared to HIV-infected men. We also report for the first time that ART-treated HIV-infected women had a lower prevalence of high-risk positively remodeled plaque (25% vs. 51%, P=0.003) and a lower number of positively remodeled plaque segments (P=0.002). In models adjusting for cardiovascular risk factors, we further showed that male sex remained associated with any coronary plaque (OR 3.8, 95%CI [1.4, 11.4]) and with positively remodeled plaque (OR 3.7, 95%CI [1.4, 10.9]).

CONCLUSIONS
ART-treated HIV-infected women (vs. HIV-infected men) had a lower prevalence and burden of subclinical coronary plaque and high-risk morphology plaque. Thus, unique sex-specific mechanisms beyond subclinical plaque may drive the higher HIV-attributable risk of MI among women vs. men.

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