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Background:  There is increasing evidence that the metabolic syndrome (MXS) predicts cardiovascular disease (CVD) and that HIV-infected individuals are at increased the risk of cardiovascular events. Many of the metabolic abnormalities observed with HIV infection and its treatment overlap with the components of the MXS. Subclinical carotid and coronary atherosclerosis are independent predictors of adverse cardiovascular events. We examined the association of MXS with carotid intima-media thickness (IMT) and coronary calcium score in NFHL, a longitudinal study examining nutritional and metabolic parameters in HIV infection.

Methods:  We measured common (CCA) and internal (ICA) IMT by B-mode ultrasonography and coronary calcium score  by high–resolution, ECG synchronized computed tomography in 327 NFHL participants. MXS was defined as having at least 3 of the following:  abdominal obesity: waist circumference > 102 cm for men, > 88 cm for women; hypertriglyceridemia: > 150 mg/dL; low high-density lipoprotein cholesterol: < 40 mg/dL for men, < 50 mg/dL for women; high blood pressure:  ≥ 130/85 mm Hg; high fasting glucose: ≥ 110 mg/dL. In this cross-sectional analysis, we compared IMT and coronary calcium score values in those with MXS versus those without MXS using χ² test for binary outcomes and ANOVA for continuous outcomes.

Results:  The prevalence of MXS and its 5 components were as follows: 2 3% MSX; 44.2% hypertriglyceridemia; 60% low HDL; 29% abdominal obesity; 6% high glucose; 26% high blood pressure. CD4, log₁₀ viral load, HAART, PI, and NNRTI use were similar between those with and without MXS. Participants with MXS were more likely to have a CCA IMT > 0.8 mm than those without MXS (17% vs 7%, p = 0.01), but they were equally likely to have ICA IMT > 1.0 mm (28% vs 20%, p = 0.16). Any positive coronary calcium score was more likely in those with MXS (80.3% vs 46.7% p = 0.0001), as was a coronary calcium score > 100 (13% vs 7% p = 0.0001). In a multivariate model adjusted for sex, age, race, and smoking, participants with MXS had significantly higher CCA IMT values than those without MXS (0.68 mm vs. 0.63 mm, p=0.03), but not higher ICA IMT or coronary calcium score.

Conclusions:  Our study demonstrates that HIV-infected individuals with MXS have higher IMT values and more abnormal coronary calcium score than those without MXS. The concurrent presence of MXS and subclinical atherosclerosis in HIV infection may help identify those at greater risk of CVD and direct therapy to prevent future CV events in this population.

Keywords: Metabolic Syndrome; Subclinical Atherosclerosis; Cardiovascular Risk Factors