David B Hanna1, Jee-Young Moon1, Sabina A Haberlen2, Audrey L French3, Frank J Palella4, Stephen J Gange2, Mallory D Witt5, Seble Kassaye6, Jason M Lazar7, Phyllis C Tien8,9, Matthew J Feinstein10, Lawrence A Kingsley11,12, Wendy S Post2,13, Robert C Kaplan1,14, Howard N Hodis15, Kathryn Anastos1,16. 1. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. 2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 3. Department of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County. 4. Department of Medicine, Northwestern University Medical Center, Chicago, Illinois. 5. Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California. 6. Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia. 7. Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York. 8. Department of Medicine. 9. Department of Veterans Affairs, University of California, San Francisco, San Francisco, California. 10. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 11. Department of Epidemiology. 12. Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania. 13. Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland. 14. Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. 15. Atherosclerosis Research Unit, University of Southern California, Los Angeles, California. 16. Department of Medicine, Montefiore Medical Center, Bronx, New York, USA.
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 > 1.5 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. 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 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. CONCLUSION: Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus.
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 > 1.5 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. 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 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. CONCLUSION: Carotid artery plaque was predictive of mortality, with differences observed by sex and HIV serostatus.
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