Coronary artery calcium and all-cause mortality in the Multicenter AIDS Cohort Study

Takahiro Suzuki; Sabina Haberlen; Tess E. Peterson; Frank Palella; Matthew J. Budoff; Mallory D. Witt; Jared W. Magnani; Wendy S. Post

doi:10.1016/j.atherosclerosis.2025.119181

Coronary artery calcium and all-cause mortality in the Multicenter AIDS Cohort Study

Takahiro Suzuki, Sabina Haberlen, Tess E. Peterson, Frank Palella, Matthew J. Budoff, Mallory D. Witt, Jared W. Magnani, Wendy S. Post^*

^*Corresponding author for this work

Medicine, Infectious Diseases Division

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

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Abstract

Background and aims: People with HIV (PWH) have greater risk of subclinical cardiovascular disease than people without HIV, but few studies have evaluated risk for mortality based on coronary artery calcium (CAC) among PWH. We aimed to determine the association between CAC and all-cause mortality among men with (MWH) and without HIV (MWOH) and if it differs by HIV serostatus. Methods: We performed a longitudinal analysis in the Multicenter AIDS Cohort Study. We included men who underwent non-contrast cardiac computed tomography. Cox regression analyses were used to examine the associations between CAC presence (Agatston score>0), and with extent of CAC (log (CAC+1)), and subsequent mortality to calculate adjusted hazard ratios [aHR]. We evaluated differences by HIV serostatus using multiplicative CAC × HIV interaction terms. Results: Among 1344 men (mean age 50 years, CAC prevalence 45.7 %, 821 [61.1 %] MWH), we observed 108 deaths (13.2 %) among MWH and 43 deaths (8.2 %) among MWOH during follow-up (median:13.4 years). CAC presence was positively associated with mortality among all participants (aHR:1.46, 95 %CI:1.02–2.10, p = 0.04) and MWH (aHR:1.62, 1.05–2.49, p = 0.03). Among MWOH, we found no significant association (aHR:1.28, 0.63–2.58, p = 0.50). The extent of CAC was associated with mortality among all participants (aHR:1.37 per SD, 1.15–1.63, p < 0.001) and MWH (aHR:1.41,1.14–1.74, p = 0.002). Among MWOH, we found no significant association (aHR:1.35, 0.98–1.85, p = 0.07). There were no significant interactions by HIV serostatus for mortality for either the presence (p = 0.35) or extent of CAC (p = 0.51). Conclusions: CAC was positively associated with mortality in a large cohort of MWH, and the overall cohort including MWH and MWOH.

Original language	English (US)
Article number	119181
Journal	Atherosclerosis
Volume	404
DOIs	https://doi.org/10.1016/j.atherosclerosis.2025.119181
State	Published - May 2025

Funding

The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). Data in this manuscript were collected by the Multicenter AIDS Cohort Study (MACS), now the MACS/WIHS Combined Cohort Study (MWCCS). The MACS coronary CT angiography studies are funded by National Heart Lung and Blood Institute (NHLBI) RO1 HL095129 (Post) and R01 HL125053 (Post). MWCCS (Principal Investigators) for former- MACS sites that participated in this analysis include: Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201; Data Analysis and Coordination Center (Gypsyamber D'Souza, Stephen Gange and Elizabeth Topper), U01-HL146193; Chicago-Northwestern CRS (Steven Wolinsky, Frank Palella, and Valentina Stosor), U01-HL146240; Los Angeles CRS (Roger Detels and Matthew Mimiaga), U01-HL146333; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo), U01-HL146208. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding NICHD, NIA, NIDCR, NIAID, NINDS, NIMH, NIDA, NINR, NCI, NIAAA, NIDCD, NIDDK, NIMHD, and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1-TR003098 (JHU ICTR), UL1-TR001881 (UCLA CTSI).

Keywords

Coronary artery calcium
Human immunodeficiency virus
Mortality

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

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

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10.1016/j.atherosclerosis.2025.119181

Cite this

@article{6c4d5bf9ad55449abf3dfc9b9c40d495,

title = "Coronary artery calcium and all-cause mortality in the Multicenter AIDS Cohort Study",

abstract = "Background and aims: People with HIV (PWH) have greater risk of subclinical cardiovascular disease than people without HIV, but few studies have evaluated risk for mortality based on coronary artery calcium (CAC) among PWH. We aimed to determine the association between CAC and all-cause mortality among men with (MWH) and without HIV (MWOH) and if it differs by HIV serostatus. Methods: We performed a longitudinal analysis in the Multicenter AIDS Cohort Study. We included men who underwent non-contrast cardiac computed tomography. Cox regression analyses were used to examine the associations between CAC presence (Agatston score>0), and with extent of CAC (log (CAC+1)), and subsequent mortality to calculate adjusted hazard ratios [aHR]. We evaluated differences by HIV serostatus using multiplicative CAC × HIV interaction terms. Results: Among 1344 men (mean age 50 years, CAC prevalence 45.7 \%, 821 [61.1 \%] MWH), we observed 108 deaths (13.2 \%) among MWH and 43 deaths (8.2 \%) among MWOH during follow-up (median:13.4 years). CAC presence was positively associated with mortality among all participants (aHR:1.46, 95 \%CI:1.02–2.10, p = 0.04) and MWH (aHR:1.62, 1.05–2.49, p = 0.03). Among MWOH, we found no significant association (aHR:1.28, 0.63–2.58, p = 0.50). The extent of CAC was associated with mortality among all participants (aHR:1.37 per SD, 1.15–1.63, p < 0.001) and MWH (aHR:1.41,1.14–1.74, p = 0.002). Among MWOH, we found no significant association (aHR:1.35, 0.98–1.85, p = 0.07). There were no significant interactions by HIV serostatus for mortality for either the presence (p = 0.35) or extent of CAC (p = 0.51). Conclusions: CAC was positively associated with mortality in a large cohort of MWH, and the overall cohort including MWH and MWOH.",

keywords = "Coronary artery calcium, Human immunodeficiency virus, Mortality",

author = "Takahiro Suzuki and Sabina Haberlen and Peterson, \{Tess E.\} and Frank Palella and Budoff, \{Matthew J.\} and Witt, \{Mallory D.\} and Magnani, \{Jared W.\} and Post, \{Wendy S.\}",

note = "Publisher Copyright: {\textcopyright} 2025 Elsevier B.V.",

year = "2025",

month = may,

doi = "10.1016/j.atherosclerosis.2025.119181",

language = "English (US)",

volume = "404",

journal = "Atherosclerosis",

issn = "0021-9150",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Coronary artery calcium and all-cause mortality in the Multicenter AIDS Cohort Study

AU - Suzuki, Takahiro

AU - Haberlen, Sabina

AU - Peterson, Tess E.

AU - Palella, Frank

AU - Budoff, Matthew J.

AU - Witt, Mallory D.

AU - Magnani, Jared W.

AU - Post, Wendy S.

PY - 2025/5

Y1 - 2025/5

N2 - Background and aims: People with HIV (PWH) have greater risk of subclinical cardiovascular disease than people without HIV, but few studies have evaluated risk for mortality based on coronary artery calcium (CAC) among PWH. We aimed to determine the association between CAC and all-cause mortality among men with (MWH) and without HIV (MWOH) and if it differs by HIV serostatus. Methods: We performed a longitudinal analysis in the Multicenter AIDS Cohort Study. We included men who underwent non-contrast cardiac computed tomography. Cox regression analyses were used to examine the associations between CAC presence (Agatston score>0), and with extent of CAC (log (CAC+1)), and subsequent mortality to calculate adjusted hazard ratios [aHR]. We evaluated differences by HIV serostatus using multiplicative CAC × HIV interaction terms. Results: Among 1344 men (mean age 50 years, CAC prevalence 45.7 %, 821 [61.1 %] MWH), we observed 108 deaths (13.2 %) among MWH and 43 deaths (8.2 %) among MWOH during follow-up (median:13.4 years). CAC presence was positively associated with mortality among all participants (aHR:1.46, 95 %CI:1.02–2.10, p = 0.04) and MWH (aHR:1.62, 1.05–2.49, p = 0.03). Among MWOH, we found no significant association (aHR:1.28, 0.63–2.58, p = 0.50). The extent of CAC was associated with mortality among all participants (aHR:1.37 per SD, 1.15–1.63, p < 0.001) and MWH (aHR:1.41,1.14–1.74, p = 0.002). Among MWOH, we found no significant association (aHR:1.35, 0.98–1.85, p = 0.07). There were no significant interactions by HIV serostatus for mortality for either the presence (p = 0.35) or extent of CAC (p = 0.51). Conclusions: CAC was positively associated with mortality in a large cohort of MWH, and the overall cohort including MWH and MWOH.

AB - Background and aims: People with HIV (PWH) have greater risk of subclinical cardiovascular disease than people without HIV, but few studies have evaluated risk for mortality based on coronary artery calcium (CAC) among PWH. We aimed to determine the association between CAC and all-cause mortality among men with (MWH) and without HIV (MWOH) and if it differs by HIV serostatus. Methods: We performed a longitudinal analysis in the Multicenter AIDS Cohort Study. We included men who underwent non-contrast cardiac computed tomography. Cox regression analyses were used to examine the associations between CAC presence (Agatston score>0), and with extent of CAC (log (CAC+1)), and subsequent mortality to calculate adjusted hazard ratios [aHR]. We evaluated differences by HIV serostatus using multiplicative CAC × HIV interaction terms. Results: Among 1344 men (mean age 50 years, CAC prevalence 45.7 %, 821 [61.1 %] MWH), we observed 108 deaths (13.2 %) among MWH and 43 deaths (8.2 %) among MWOH during follow-up (median:13.4 years). CAC presence was positively associated with mortality among all participants (aHR:1.46, 95 %CI:1.02–2.10, p = 0.04) and MWH (aHR:1.62, 1.05–2.49, p = 0.03). Among MWOH, we found no significant association (aHR:1.28, 0.63–2.58, p = 0.50). The extent of CAC was associated with mortality among all participants (aHR:1.37 per SD, 1.15–1.63, p < 0.001) and MWH (aHR:1.41,1.14–1.74, p = 0.002). Among MWOH, we found no significant association (aHR:1.35, 0.98–1.85, p = 0.07). There were no significant interactions by HIV serostatus for mortality for either the presence (p = 0.35) or extent of CAC (p = 0.51). Conclusions: CAC was positively associated with mortality in a large cohort of MWH, and the overall cohort including MWH and MWOH.

KW - Coronary artery calcium

KW - Human immunodeficiency virus

KW - Mortality

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DO - 10.1016/j.atherosclerosis.2025.119181

M3 - Article

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SN - 0021-9150

VL - 404

JO - Atherosclerosis

JF - Atherosclerosis

M1 - 119181

ER -

Coronary artery calcium and all-cause mortality in the Multicenter AIDS Cohort Study

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