Impaired distensibility of ascending aorta in patients with HIV infection

BMC Infectious Diseases

Theodore Kordossis³  Panayiotis D Ziakas³  Athanasios N Kontos³  Maria N Gamaletsou³  Sarah P Georgiadou³  Ioannis Moyssakis¹  Nikolaos V Sipsas³  Alexandra Zormpala² 

[1] Cardiology Department, Laikon General Hospital of Athens, Mikras Asias 75, 11527, Athens, Greece;Radiology Department, Laikon General Hospital of Athens, Medical School, National and Kapodistrian University, Mikras Asias 75, 11527, Athens, Greece;Infectious Diseases Unit, Pathophysiology Department, Laikon General Hospital, Medical School, National and Kapodistrian University, Mikras Asias 75, 11527, Athens, Greece

关键词: Carotid artery intima-media thickness;    Atherosclerosis;    HAART;    Aortic distensibility;    HIV;   

Others  :  1175324
DOI  :  10.1186/1471-2334-12-167

 received in 2011-05-01, accepted in 2012-06-21,  发布年份 2012

【 摘 要 】

Background

Our aim was to investigate the aortic distensibility (AD) of the ascending aorta and carotid artery intima-media thickness (c-IMT) in HIV-infected patients compared to healthy controls.

Methods

One hundred and five HIV-infected patients (86 males [82%], mean age 41 ± 0.92 years), and 124 age and sex matched HIV-1 uninfected controls (104 males [84%], mean age 39.2 ± 1.03 years) were evaluated by high-resolution ultrasonography to determine AD and c-IMT. For all patients and controls clinical and laboratory factors associated with atherosclerosis were recorded.

Results

HIV- infected patients had reduced AD compared to controls: 2.2 ± 0.01 vs. 2.62 ± 0.01 10^-6 cm² dyn^-1, respectively (p < 0.001). No difference was found in c-IMT between the two groups. In multiadjusted analysis, HIV infection was independently associated with decreased distensibility (beta –0.45, p < 0.001). Analysis among HIV-infected patients showed that patients exposed to HAART had decreased AD compared to HAART-naïve patients [mean (SD): 2.18(0.02) vs. 2.28(0.03) 10^-6 cm² dyn^-1, p = 0.01]. In multiadjusted analysis, increasing age and exposure to HAART were independently associated with decreased AD.

Conclusion

HIV infection is independently associated with decreased distensibility of the ascending aorta, a marker of subclinical atherosclerosis. Increasing age and duration of exposure to HAART are factors further contributing to decreased AD.

【 授权许可】

   
2012 Zormpala et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Sterne JA, Hernán MA, Ledergerber B, Tilling K, Weber R, Sendi P, et al.: Swiss HIV Cohort Study. Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study. Lancet 2005, 366:378-384.
• [2]Riddler SA, Li X, Chu H, Kingsley LA, Dobs A, Evans R, et al.: Longitudinal changes in serum lipids among HIV-infected men on highly active antiretroviral therapy. HIV Med 2007, 8:280-287.
• [3]Calza L, Manfredi R, Chiodo F: Dyslipidaemia associated with antiretroviral therapy in HIV-infected patients. J Antimicrob Chemother 2004, 53:10.
• [4]Riddler SA, Smit E, Cole SR, Li R, Chmiel JS, Dobs A, et al.: Impact of HIV infection and HAART on serum lipids in men. JAMA 2003, 289:2978-2982.
• [5]Morse CG, Kovacs JA: Metabolic and skeletal complications of HIV infection: the price of success. JAMA 2006, 296:844-854.
• [6]d'Arminio A, Sabin CA, Phillips AN, Reiss P, Weber R, Kirk O, et al.: Writing Committee of the D:A:D: Study Group. Cardio- and cerebrovascular events in HIV-infected persons. AIDS 2004, 18:1811-1817.
• [7]Friis-Møller N, Reiss P, Sabin CA, Weber R, Monforte A, El-Sadr W, DAD Study Group: Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med 2007, 356:1723-1735.
• [8]Sabin CA, Worm SW, Weber R, Reiss P, El-Sadr W, Dabis F, D:A:D Study Group: Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the DAD study: a multi-cohort collaboration. Lancet 2008, 371:1417-1426.
• [9]Roman MJ, Devereux RB, Schwartz JE, Lockshin MD, Paget SA, Davis A, et al.: Arterial stiffness in chronic inflammatory diseases. Hypertension 2005, 46:194-199.
• [10]Currier JS: Update on cardiovascular complications in HIV infection. Top HIV Med 2009, 17:98-103.
• [11]Martínez E, Larrousse M, Gatell JM: Cardiovascular disease and HIV infection: host, virus, or drugs? Curr Opin Infect Dis 2009, 22:28-34.
• [12]Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, et al.: Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006, 113:664-670.
• [13]Shokawa T, Imazu M, Yamamoto H, Toyofuku M, Tasaki N, Okimoto T, et al.: Pulse wave velocity predicts cardiovascular mortality: findings from the Hawaii-Los Angeles-Hiroshima study. Circ J 2005, 69:259-264.
• [14]Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al.: Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001, 37:1236-1241.
• [15]Sutton-Tyrrell K, Najjar SS, Boudreau RM, Venkitachalam L, Kupelian V, Simonsick EM, et al.: Health ABC Study. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation 2005, 111:3384-3390.
• [16]Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al.: Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation 2006, 113:657-663.
• [17]Moyssakis I, Gialafos E, Vassiliou VA, Boki K, Votteas V, Sfikakis PP, et al.: Myocardial performance and aortic elasticity are impaired in patients with ankylosing spondylitis. Scand J Rheumatol 2009, 38:216-221.
• [18]Moyssakis I, Gialafos E, Tentolouris N, Floudas CS, Papaioannou TG, Kostopoulos C, et al.: Impaired aortic elastic properties in patients with systemic sarcoidosis. Eur J Clin Invest 2008, 38:82-89.
• [19]Moyssakis I, Gialafos E, Vassiliou V, Taktikou E, Katsiari C, Papadopoulos DP, et al.: Aortic stiffness in systemic sclerosis is increased independently of the extent of skin involvement. Rheumatology (Oxford) 2005, 44:251-254.
• [20]Margos PN, Moyssakis IE, Tzioufas AG, Zintzaras E, Moutsopoulos HM: Impaired elastic properties of ascending aorta in patients with giant cell arteritis. Ann Rheum Dis 2005, 64:253-256.
• [21]Tentolouris N, Liatis S, Moyssakis I, Tsapogas P, Psallas M, Diakoumopoulou E, et al.: Aortic distensibility is reduced in subjects with type 2 diabetes and cardiac autonomic neuropathy. Eur J Clin Invest 2003, 33:1075-1083.
• [22]Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE: Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 1997, 96:1432-1437.
• [23]Lorenz MW, von Kegler S, Steinmetz H, Markus HS, Sitzer M: Carotid intima-media thickening indicates a higher vascular risk across a wide age range: prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Stroke 2006, 37:87-92.
• [24]O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK: Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999, 340:14-22.
• [25]Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, et al.: American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008, 21:93-111.
• [26]Stefanadis C, Stratos C, Boudoulas H, Kourouklis C, Toutouzas P: Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with arterial disease. Eur Heart J 1990, 11:990-996.
• [27]Stefanadis C, Dernellis J, Vlachopoulos C, Tsioufis C, Tsiamis E, Toutouzas K, et al.: Aortic function in arterial hypertension determined by pressure-diameter relation: effects of diltiazem. Circulation 1997, 96:1853-1858.
• [28]Boudoulas H, Wooley CF: Aortic function. In Functional abnormalities of the aorta. Edited by Toutouzas PK, Wooley CF. Futura Publishing Co. Inc, Armonk, NY; 1996:3-36.
• [29]Malayeri AA, Natori S, Bahrami H, Bertoni AG, Kronmal R, Lima JA, et al.: Relation of aortic wall thickness and distensibility to cardiovascular risk factors (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2008, 102:491-496.
• [30]van Vonderen MG, Smulders YM, Stehouwer CD, Danner SA, Gundy CM, Vos F, et al.: Carotid intima-media thickness and arterial stiffness in HIV-infected patients: the role of HIV, antiretroviral therapy, and lipodystrophy. J Acquir Immune Defic Syndr 2009, 50:153-161.
• [31]Kaplan RC, Sinclair E, Landay AL, Lurain N, Sharrett AR, Gange SJ, et al.: T cell activation and senescence predict subclinical carotid artery disease in HIV-infected women. J Infect Dis 2011, 203:452-463.
• [32]Seaberg EC, Benning L, Sharrett AR, Lazar JM, Hodis HN, Mack WJ, et al.: Association between human immunodeficiency virus infection and stiffness of the common carotid artery. Stroke 2010, 41:2163-2170.
• [33]van Vonderen MG, Hassink EA, van Agtmael MA, Stehouwer CD, Danner SA, Reiss P, et al.: Increase in carotid artery intima-media thickness and arterial stiffness but improvement in several markers of endothelial function after initiation of antiretroviral therapy. J Infect Dis 2009, 199:1186-1194.
• [34]Baker JV, Duprez D, Rapkin J, Hullsiek KH, Quick H, Grimm R, Neaton JD, Henry K, et al.: Untreated HIV infection and large and small artery elasticity. J Acquir Immune Defic Syndr 2009, 52:25-31.
• [35]Schillaci G, De Socio GV, Pirro M, Savarese G, Mannarino MR, Baldelli F, Stagni G, Mannarino E, et al.: Impact of treatment with protease inhibitors on aortic stiffness in adult patients with human immunodeficiency virus infection. Arterioscler Thromb Vasc Biol 2005, 25:2381-2385.
• [36]Schillaci G, De Socio GV, Pucci G, Mannarino MR, Helou J, Pirro M, Mannarino E, et al.: Aortic stiffness in untreated adult patients with human immunodeficiency virus infection. Hypertension 2008, 52:308-313.
• [37]Guaraldi G, Zona S, Alexopoulos N, Orlando G, Carli F, Ligabue G, et al.: Coronary aging in HIV-infected patients. Clin Infect Dis 2009, 49:1756-1762.
• [38]De Socio GV, Ricci E, Parruti G, Maggi P, Madeddu G, Quirino T, Bonfanti P, et al.: Chronological and biological age in HIV infection. J Infect 2010, 61:428-430.
• [39]Ross AC, Storer N, O'Riordan MA, Dogra V, McComsey GA: Longitudinal changes in carotid intima-media thickness and cardiovascular risk factors in human immunodeficiency virus-infected children and young adults compared with healthy controls. Pediatr Infect Dis J 2010, 29:634-638.
• [40]Vigano A, Bedogni G, Cerini C, Meroni L, Giacomet V, Stucchi S, et al.: Both HIV-infection and long-term antiretroviral therapy are associated with increased common carotid intima-media thickness in HIV-infected adolescents and young adults. Curr HIV Res 2010, 8:411-417.
• [41]Hsue PY, Hunt PW, Schnell A, Kalapus SC, Hoh R, Ganz P, et al.: Role of viral replication, antiretroviral therapy, and immunodeficiency in HIV-associated atherosclerosis. AIDS 2009, 23:1059-1067.
• [42]Oliviero U, Bonadies G, Apuzzi V, Foggia M, Bosso G, Nappa S, et al.: Human immunodeficiency virus per se exerts atherogenic effects. Atherosclerosis 2009, 204:586-589.
• [43]Lorenz MW, Stephan C, Harmjanz A, Staszewski S, Buehler A, Bickel M, et al.: Both long-term HIV infection and highly active antiretroviral therapy are independent risk factors for early carotid atherosclerosis. Atherosclerosis 2008, 196:720-726.
• [44]Hsue PY, Lo JC, Franklin A, Bolger AF, Martin JN, Deeks SG, et al.: Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection. Circulation 2004, 109:1603-1608.
• [45]Bonnet D, Aggoun Y, Szezepanski I, Bellal N, Blanche S: Arterial stiffness and endothelial dysfunction in HIV-infected children. AIDS 2004, 18:1037-1041.
• [46]Currier JS, Kendall MA, Zackin R, Henry WK, Alston-Smith B, Torriani FJ, AACTG 5078 Study Team: Carotid artery intima-media thickness and HIV infection: traditional risk factors overshadow impact of protease inhibitor exposure. AIDS 2005, 19:927-933.
• [47]Currier JS, Kendall MA, Henry WK, Alston-Smith B, Torriani FJ, Tebas P, et al.: Progression of carotid artery intima-media thickening in HIV-infected and uninfected adults. AIDS 2007, 21:1137-1145.
• [48]Mercié P, Thiébaut R, Lavignolle V, Pellegrin JL, Yvorra-Vives MC, Morlat P, et al.: Evaluation of cardiovascular risk factors in HIV-1 infected patients using carotid intima-media thickness measurement. Ann Med 2002, 34:55-63.
• [49]Henry RM, Kostense PJ, Spijkerman AM, Dekker JM, Nijpels G, Heine RJ, et al.: Arterial stiffness increases with deteriorating glucose tolerance status: the Hoorn Study. Circulation 2003, 107:2089-2095.
• [50]van der Heijden-Spek JJ, Staessen JA, Fagard RH, Hoeks AP, Boudier HA, van Bortel LM: Effect of age on brachial artery wall properties differs from the aorta and is gender dependent: a population study. Hypertension 2000, 35:637-642.
• [51]Ferreira I, Henry RM, Twisk JW, van Mechelen W, Kemper HC, Stehouwer CD: The metabolic syndrome, cardiopulmonary fitness, and subcutaneous trunk fat as independent determinants of arterial stiffness: the Amsterdam Growth and Health Longitudinal Study. Arch Intern Med 2005, 165:875-882.
• [52]Fisher SD, Miller TL, Lipshultz SE: Impact of HIV and highly active antiretroviral therapy on leukocyte adhesion molecules, arterial inflammation, dyslipidemia, and atherosclerosis. Atherosclerosis 2006, 185:1-11.
• [53]Torriani F: Antiretroviral therapy improves endothelial function in treatment-naive HIV infected patients: a prospective, randomized multicenter trial (A5152s. EACS, Dublin; 2005. Presented at
• [54]Gatzka CD, Cameron JD, Kingwell BA, Dart AM: Relation between coronary artery disease, aortic stiffness, and left ventricular structure in a population sample. Hypertension 1998, 32:575-578.
• [55]Dart AM, Lacombe F, Yeoh JK, Cameron JD, Jennings GL, Laufer E, et al.: Aortic distensibility in patients with isolated hypercholesterolaemia, coronary artery disease, or cardiac transplant. Lancet 1991, 338:270-273.
• [56]Eren M, Gorgulu S, Uslu N, Celik S, Dagdeviren B, Tezel T: Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes or both. Heart 2004, 90:37-43.
• [57]Lacombe F, Dart A, Dewar E, Jennings G, Cameron J, Laufer E: Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J 1992, 13:1040-1045.