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.
Nested cohort study.
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 > 1.5 mm) 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.
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 person-years, 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.
Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus.
aDepartment of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
bDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
cDepartment of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County
dDepartment of Medicine, Northwestern University Medical Center, Chicago, Illinois
eDepartment of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
fDepartment of Medicine, Georgetown University Medical Center, Washington, District of Columbia
gDepartment of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York
hDepartment of Medicine
iDepartment of Veterans Affairs, University of California, San Francisco, San Francisco, California
jDepartment of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
kDepartment of Epidemiology
lDepartment of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
mDepartment of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
nPublic Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
oAtherosclerosis Research Unit, University of Southern California, Los Angeles, California
pDepartment of Medicine, Montefiore Medical Center, Bronx, New York, USA.
Correspondence to David B. Hanna, PhD, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer 1306C, Bronx, NY 10461, USA. Tel: +1 718 839 7904; fax: +1 718 430 8780; e-mail: firstname.lastname@example.org
Received 7 May, 2018
Accepted 28 June, 2018
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