NATAP/CROI: Lipoatrophy & Heart Disease/Plaque in MACS

[Guest guest]

Subject: NATAP/CROI: Lipoatrophy & Heart Disease/Plaque in MACS

Associations

between Anatomic Fat Depots with Total, Calcified, Non-Calcified and Mixed

Coronary Plaque in the Multicenter AIDS Cohort Study (MACS) - see attached full poster report

Reported by Jules

LevinCROI 2012 Seattle

March 5-8

J. Palella Jrfrom Jules: this study reports less body fat (lipoatrophy) is associated with coronary plaque. There are 2 types of plaque, calcified &

non-calcified. Different types of fat depots (less fat in SAT, more fat in

belly) are differentially associated with different types of plaque.

Differential associations exist between adiposity and subclinical

coronary plaque amount and type by HIV status:- lesser SAT (subcutaneous fat) correlates with greater TPS, NCP and MP

- In HIV+ less subcutaneous adipose tissue was associated with

greater mixed plaque

- Greater visceral adipose tissue was associated with higher total plaque

scores (OR 1.03/10 units, p = 0.009)

in the entire cohort without interaction by HIV status

- trends toward greater total plaque scores with more subcutaneous fat in

HIV–

- Fatty liver was associated with greater total plaque scores

SUMMARY & CONCLUSIONS

TPS- total plaque scoreNCP= non-calcified plaque scoreCP= calcified plaque scoreMP=mixed plaque scoreTF= thigh fatVAT- visceral (belly) fatSAT= subcutaneous fat

1.Associations exist between adiposity and subclinical

coronary plaque amount but these differ by HIV serostatus and plaque type.

2.Among HIV+ men:

• lesser

SAT correlates with greater TPS, NCP and MP (with significant or

near-significant interactions by HIV status for each).

• lesser

TF correlates with greater TPS

• more

VAT correlates with greater TPS,

NCP and CP, with the former two

mediated through traditional CAD risk factors, and the latter including a

significant interaction by HIV serostatus

• fatty

liver correlates with greater TPS and MP

3. In HIV-uninfected

men SAT tended to be associated

with more MP.

4. Clinicians should be

aware of the differential associations between anatomic fat depots and coronary

plaque when undertaking CAD risk assessment in HIV-infected persons.

ABSTRACTBackground:

Body fat depots are associated with

coronary artery disease (CAD). HIV+ persons may be at greater CAD

risk. Methods:

The Multicenter AIDS Cohort Study (MACS) performed coronary CT angiography on

452 HIV+ and HIV– men. Plaque was graded in coronary

segments to generate scores for total, non-calcified, mixed, and calcified

plaque. We measured abdominal (visceral and subcutaneous) adipose tissue, thigh

fat and liver fat with non-contrast CT scans. Fatty liver was defined as mean

liver HU <40. Logistic regression examined associations between fat

depots and the top quartile of plaque scores compared with the combined lower

quartiles, adjusted for age and HIV status, then CAD risk factors; then tested

for interactions by HIV status. Correlations with serum interleukin-6 (IL-6)

levels were made. Results:

Greater visceral adipose tissue was

associated with higher total plaque scores (OR 1.03/10 units, p = 0.009) in the entire cohort without

interaction by HIV status. When CAD risk factors were added, this attenuated

(OR 1.02, p = 0.24).

Associations between subcutaneous fat and thigh fat with total plaque scored

differed by HIV serostatus (p = 0.03

for both interactions) with trends toward greater total plaque scores with more

subcutaneous fat in HIV– (p

= 0.12) and an inverse association in HIV+ for total plaque scores

and thigh fat (OR 0.86, p = 0.04) and

for total plaque scores and subcutaneous adipose tissue (p = 0.13). Fatty liver was associated with greater total plaque

scores (OR 3.64, p = 0.013); after

adjusting for CAD risk factors this attenuated (OR 2.78, p = 0.076). A positive trend in HIV+ existed between

fatty liver and greater total plaque scores in adjusted models (OR 3.06, p = 0.117). Greater visceral adipose

tissue was associated with more non-calcified plaque (p <0.05), but significance attenuated in adjusted models (p = 0.54). In HIV+ less

subcutaneous adipose tissue was associated with greater mixed plaque and

persisted after adjustment (OR 0.97, p

= 0.03); more subcutaneous fat tended to be associated with greater mixed

plaque in HIV– (p = 0.20).

There was a positive association between fatty liver and mixed plaque (OR 2.99,

p = 0.034) that attenuated after

adjustment for CAD risks (OR 2.46, p

= 0.1). HIV+ were more likely than HIV– (OR 3.56, p = 0.048) to have an association

between fatty liver and mixed plaque. Among HIV+, in fully adjusted

models there was a borderline significant positive association between fatty

liver and greater mixed plaque (OR 3.57, p

= 0.058). Adjustment for IL-6 levels did not modify associations. Conclusions:

Differential associations exist between adiposity and subclinical

coronary plaque amount and type by HIV status. In HIV+ men lesser

subcutaneous fat or fatty liver correlate with greater total plaque scores and

mixed plaque; in HIV– men more subcutaneous fat tended to be

associated with more plaque. Visceral adipose tissue is associated with

non-calcified plaque.