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Risk for Cardiovascular Disease and Regional Adipose Tissue Depots among HIV-infected Men and Women in the Study of Fat Redistribution and Metabolic Changes in HIV Infection
David Wohl*1, J Currier2, E Madden3, R Scherzer3, P Tien3, and C Grunfeld4
1Univ of North Carolina at Chapel Hill, US; 2Univ of California, Los Angeles, US; 3VAMC, San Francisco, CA, US; and 4Univ of California, San Francisco, US
Background: Several studies suggest that HIV+
individuals are at heightened risk of cardiovascular disease (CVD), but the
effect of regional adipose tissue on dyslipidemia, diabetes, and overall CVD
risk in such patients is not well described.
Methods: We evaluated the prevalence of
dyslipidemia, diabetes, and CVD risk in a cross-sectional analysis of 1103 HIV+
men and women from the FRAM study. Presented is the analysis of the
relationship between regional body fat and dyslipidemia, diabetes and CVD risk
as assessed using the 10-year CVD Framingham Risk Score (FRS). Regional fat
volumes were measured using whole-body magnetic resonance imaging. Cholesterol
subsets including direct LDL-c, triglyceride and glucose levels were measured
after an 8-hour fast.
Results: The median age was 40 (IQR 37 to 43) for
men and 39 (IQR 36 to 42) for women; 43% of the men and 67% of women were
non-white. Smoking was common with 45% of men and 50% of women currently
smoking. Diabetes (fasting glucose ≥126 mg/dL or currently using
hypoglycemic medications) was present in 5% of men and 9% of women. For men,
the median FRS was 4.7% (IQR 2.8% to 8.1%) and 16% had an estimated 10-year CVD
risk ≥10%. However, for women, the median FRS was 1.1% (IQR 0.05% to 2.6%)
and only 3% had a ≥10% estimated 10-year risk of CVD. For both sexes,
increased visceral adipose tissue (VAT) was associated with higher prevalence
of triglycerides >500 mg/dL, LDL-c >160 mg/dL, non-HDL-c>190 mg/dL,
low HDL-c (<40 mg/dL men, <50 mg/dL women), diabetes and elevated FRS
(all p ≤0.05, except triglycerides>500 mg/dL in women). In
contrast, decreased leg subcutaneous adipose tissue (SAT) was associated with
elevated triglycerides and non-HDL-c, as well as increased FRS. A negative
association of leg SAT with prevalence of diabetes was found in women, but not
men. Increased upper trunk SAT was associated with higher prevalence of high
non-HDL-c in men, low HDL-C levels, higher prevalence of diabetes and higher
FRS (more strongly in men than women).
Conclusions: In HIV+ patients, regional
fat depots including increased VAT and upper trunk SAT and decreased leg SAT
are associated with individual CVD risk factors as well as overall CVD risk. Heightened
screening for CVD risk factors should be performed in HIV+ patients
with evidence of these fat distributions.
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