Carotid artery atherosclerosis is associated with mortality in HIV-positive women and men

David B. Hanna; Jee Young Moon; Sabina A. Haberlen; Audrey L. French; Frank J. Palella; Stephen J. Gange; Mallory D. Witt; Seble Kassaye; Jason M. Lazar; Phyllis C. Tien; Matthew J. Feinstein; Lawrence A. Kingsley; Wendy S. Post; Robert C. Kaplan; Howard N. Hodis; Kathryn Anastos

doi:10.1097/QAD.0000000000001972

Carotid artery atherosclerosis is associated with mortality in HIV-positive women and men

David B. Hanna^*, Jee Young Moon, Sabina A. Haberlen, Audrey L. French, Frank J. Palella, Stephen J. Gange, Mallory D. Witt, Seble Kassaye, Jason M. Lazar, Phyllis C. Tien, Matthew J. Feinstein, Lawrence A. Kingsley, Wendy S. Post, Robert C. Kaplan, Howard N. Hodis, Kathryn Anastos

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

25 Scopus citations

Abstract

Objective: Among people with HIV, there are few long-Term studies of noninvasive ultrasound-based measurements of the carotid artery predicting major health events. We hypothesized that such measurements are associated with 10-year mortality in the Women s Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS), and that associations differ by HIV serostatus. Design: Nested cohort study. Methods: Participants without coronary heart disease underwent B-mode carotid artery ultrasound, with measurement of common carotid artery intima-media thickness (IMT); carotid artery plaque (focal IMT 1.5mm) at six locations; and Young s modulus of elasticity, a measure of arterial stiffness. We examined all-cause mortality using Cox models, controlling for demographic, behavioral, cardiometabolic, and HIV-related factors. Results: Among 1722 women (median age 40 years, 90% nonwhite, 71% HIV-positive) and 1304 men (median age 50, 39% nonwhite, 62% HIV-positive), 11% died during follow-up. Mortality was higher among HIV-positive women [19.9 deaths/1000 personyears, 95% confidence interval (CI) 14.7-28.8] than HIV-positive men (15.1/1000, 95% CI 8.3-26.8). In adjusted analyses, plaque was associated with mortality (hazard ratio 1.44, 95% CI 1.10-1.88) regardless of HIV serostatus, and varied by sex (among women, hazard ratio 1.06, 95% CI 0.74-1.52; among men; hazard ratio 2.19, 95% CI 1.41-3.43). The association of plaque with mortality was more pronounced among HIV-negative (hazard ratio 3.87, 95% 1.95-7.66) than HIV-positive participants (hazard ratio 1.35, 95% CI 1.00-1.84). Arterial stiffness was also associated with mortality (hazard ratio 1.43 for highest versus lowest quartile, 95% CI 1.02-2.01). Greater common carotid artery-IMT was not associated with mortality. Conclusion: Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus.

Original language	English (US)
Pages (from-to)	2393-2403
Number of pages	11
Journal	AIDS
Volume	32
Issue number	16
DOIs	https://doi.org/10.1097/QAD.0000000000001972
State	Published - 2018

Funding

MACS (principal Investigators): Johns Hopkins University Bloomberg School of Public Health (Joseph Margolick), U01-AI35042; Northwestern University (Steven Wolinsky), U01-AI35039; University of California, Los Angeles (Roger Detels), U01-AI35040; University of Pittsburgh (Charles Rinaldo), U01-AI35041; the Center for Analysis and Management of MACS, Johns Hopkins University Bloomberg School of Public Health (Lisa Jacobson), UM1-AI35043. The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health, with additional cofunding from the National Cancer Institute (NCI). Targeted supplemental funding for specific projects was also provided by the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute on Deafness and Communication Disorders (NIDCD). MACS data collection is also supported by UL1-TR000424 (JHU CTSA). The current work was also supported by the National Institutes of Health (K01-HL-137557 and R21-AG-060860 to D.B.H.; R01-HL-083760, R01-HL-095140, and R01-HL-126543 to R.C.K.; and R01-HL-095129 to W.S.P.). WIHS (principal investigators): Bronx WIHS (K.A. and Anjali Sharma), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and A.L.F.), U01-AI-034993; Metropolitan Washington WIHS (S.K.), U01-AI-034994; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and P.C.T.), U01-AI-034989; WIHS Data Management and Analysis Center (S.J.G. and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Joel Milam). U01-HD-032632 (WIHS I–WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health, with additional cofunding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA).

Keywords

HIV
arterial stiffness
atherosclerosis
intima-media thickness
mortality
plaque

ASJC Scopus subject areas

Infectious Diseases
Immunology and Allergy
Immunology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1097/QAD.0000000000001972

Cite this

Hanna, D. B., Moon, J. Y., Haberlen, S. A., French, A. L., Palella, F. J., Gange, S. J., Witt, M. D., Kassaye, S., Lazar, J. M., Tien, P. C., Feinstein, M. J., Kingsley, L. A., Post, W. S., Kaplan, R. C., Hodis, H. N., & Anastos, K. (2018). Carotid artery atherosclerosis is associated with mortality in HIV-positive women and men. AIDS, 32(16), 2393-2403. https://doi.org/10.1097/QAD.0000000000001972

@article{0820230d07f440e89517b8d6f0db0773,

title = "Carotid artery atherosclerosis is associated with mortality in HIV-positive women and men",

abstract = "Objective: Among people with HIV, there are few long-Term studies of noninvasive ultrasound-based measurements of the carotid artery predicting major health events. We hypothesized that such measurements are associated with 10-year mortality in the Women s Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS), and that associations differ by HIV serostatus. Design: Nested cohort study. Methods: Participants without coronary heart disease underwent B-mode carotid artery ultrasound, with measurement of common carotid artery intima-media thickness (IMT); carotid artery plaque (focal IMT 1.5mm) at six locations; and Young s modulus of elasticity, a measure of arterial stiffness. We examined all-cause mortality using Cox models, controlling for demographic, behavioral, cardiometabolic, and HIV-related factors. Results: Among 1722 women (median age 40 years, 90% nonwhite, 71% HIV-positive) and 1304 men (median age 50, 39% nonwhite, 62% HIV-positive), 11% died during follow-up. Mortality was higher among HIV-positive women [19.9 deaths/1000 personyears, 95% confidence interval (CI) 14.7-28.8] than HIV-positive men (15.1/1000, 95% CI 8.3-26.8). In adjusted analyses, plaque was associated with mortality (hazard ratio 1.44, 95% CI 1.10-1.88) regardless of HIV serostatus, and varied by sex (among women, hazard ratio 1.06, 95% CI 0.74-1.52; among men; hazard ratio 2.19, 95% CI 1.41-3.43). The association of plaque with mortality was more pronounced among HIV-negative (hazard ratio 3.87, 95% 1.95-7.66) than HIV-positive participants (hazard ratio 1.35, 95% CI 1.00-1.84). Arterial stiffness was also associated with mortality (hazard ratio 1.43 for highest versus lowest quartile, 95% CI 1.02-2.01). Greater common carotid artery-IMT was not associated with mortality. Conclusion: Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus.",

keywords = "HIV, arterial stiffness, atherosclerosis, intima-media thickness, mortality, plaque",

author = "Hanna, {David B.} and Moon, {Jee Young} and Haberlen, {Sabina A.} and French, {Audrey L.} and Palella, {Frank J.} and Gange, {Stephen J.} and Witt, {Mallory D.} and Seble Kassaye and Lazar, {Jason M.} and Tien, {Phyllis C.} and Feinstein, {Matthew J.} and Kingsley, {Lawrence A.} and Post, {Wendy S.} and Kaplan, {Robert C.} and Hodis, {Howard N.} and Kathryn Anastos",

year = "2018",

doi = "10.1097/QAD.0000000000001972",

language = "English (US)",

volume = "32",

pages = "2393--2403",

journal = "AIDS",

issn = "0269-9370",

publisher = "Lippincott Williams and Wilkins",

number = "16",

}

TY - JOUR

T1 - Carotid artery atherosclerosis is associated with mortality in HIV-positive women and men

AU - Hanna, David B.

AU - Moon, Jee Young

AU - Haberlen, Sabina A.

AU - French, Audrey L.

AU - Palella, Frank J.

AU - Gange, Stephen J.

AU - Witt, Mallory D.

AU - Kassaye, Seble

AU - Lazar, Jason M.

AU - Tien, Phyllis C.

AU - Feinstein, Matthew J.

AU - Kingsley, Lawrence A.

AU - Post, Wendy S.

AU - Kaplan, Robert C.

AU - Hodis, Howard N.

AU - Anastos, Kathryn

PY - 2018

Y1 - 2018

N2 - Objective: Among people with HIV, there are few long-Term studies of noninvasive ultrasound-based measurements of the carotid artery predicting major health events. We hypothesized that such measurements are associated with 10-year mortality in the Women s Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS), and that associations differ by HIV serostatus. Design: Nested cohort study. Methods: Participants without coronary heart disease underwent B-mode carotid artery ultrasound, with measurement of common carotid artery intima-media thickness (IMT); carotid artery plaque (focal IMT 1.5mm) at six locations; and Young s modulus of elasticity, a measure of arterial stiffness. We examined all-cause mortality using Cox models, controlling for demographic, behavioral, cardiometabolic, and HIV-related factors. Results: Among 1722 women (median age 40 years, 90% nonwhite, 71% HIV-positive) and 1304 men (median age 50, 39% nonwhite, 62% HIV-positive), 11% died during follow-up. Mortality was higher among HIV-positive women [19.9 deaths/1000 personyears, 95% confidence interval (CI) 14.7-28.8] than HIV-positive men (15.1/1000, 95% CI 8.3-26.8). In adjusted analyses, plaque was associated with mortality (hazard ratio 1.44, 95% CI 1.10-1.88) regardless of HIV serostatus, and varied by sex (among women, hazard ratio 1.06, 95% CI 0.74-1.52; among men; hazard ratio 2.19, 95% CI 1.41-3.43). The association of plaque with mortality was more pronounced among HIV-negative (hazard ratio 3.87, 95% 1.95-7.66) than HIV-positive participants (hazard ratio 1.35, 95% CI 1.00-1.84). Arterial stiffness was also associated with mortality (hazard ratio 1.43 for highest versus lowest quartile, 95% CI 1.02-2.01). Greater common carotid artery-IMT was not associated with mortality. Conclusion: Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus.

AB - Objective: Among people with HIV, there are few long-Term studies of noninvasive ultrasound-based measurements of the carotid artery predicting major health events. We hypothesized that such measurements are associated with 10-year mortality in the Women s Interagency HIV Study (WIHS) and Multicenter AIDS Cohort Study (MACS), and that associations differ by HIV serostatus. Design: Nested cohort study. Methods: Participants without coronary heart disease underwent B-mode carotid artery ultrasound, with measurement of common carotid artery intima-media thickness (IMT); carotid artery plaque (focal IMT 1.5mm) at six locations; and Young s modulus of elasticity, a measure of arterial stiffness. We examined all-cause mortality using Cox models, controlling for demographic, behavioral, cardiometabolic, and HIV-related factors. Results: Among 1722 women (median age 40 years, 90% nonwhite, 71% HIV-positive) and 1304 men (median age 50, 39% nonwhite, 62% HIV-positive), 11% died during follow-up. Mortality was higher among HIV-positive women [19.9 deaths/1000 personyears, 95% confidence interval (CI) 14.7-28.8] than HIV-positive men (15.1/1000, 95% CI 8.3-26.8). In adjusted analyses, plaque was associated with mortality (hazard ratio 1.44, 95% CI 1.10-1.88) regardless of HIV serostatus, and varied by sex (among women, hazard ratio 1.06, 95% CI 0.74-1.52; among men; hazard ratio 2.19, 95% CI 1.41-3.43). The association of plaque with mortality was more pronounced among HIV-negative (hazard ratio 3.87, 95% 1.95-7.66) than HIV-positive participants (hazard ratio 1.35, 95% CI 1.00-1.84). Arterial stiffness was also associated with mortality (hazard ratio 1.43 for highest versus lowest quartile, 95% CI 1.02-2.01). Greater common carotid artery-IMT was not associated with mortality. Conclusion: Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus.

KW - HIV

KW - arterial stiffness

KW - atherosclerosis

KW - intima-media thickness

KW - mortality

KW - plaque

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ER -

Carotid artery atherosclerosis is associated with mortality in HIV-positive women and men

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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