Coronary Plaque Prevalence Among Black Women Living with HIV Pubblico
Vatsa, Nishant (Spring 2025)
Abstract
Introduction
Previous studies indicate that people living with human immunodeficiency virus (HIV) have a greater burden of coronary artery plaque, especially noncalcified plaque. However, many of these studies primarily included white males receiving outdated HIV management practices. A contemporary investigation examining plaque prevalence in Black women living with HIV (WLH) is needed.
Methods
We performed Coronary Computed Tomography Angiography (CCTA) in 86 Black WLH and women without HIV (WWoH) asymptomatic of cardiac symptoms from the Atlanta metro area (70.9% WLH, median age: 55 [49.25, 59]). Individuals with calcified, noncalcified, mixed plaque or plaque with positive remodeling, low attenuation, napkin ring sign, and spotty calcification features on visual or semi-automated CCTA analyses were categorized as having CCTA plaque. We compared plaque prevalence across HIV strata in the overall sample and among those with low cardiac risk per coronary artery calcium (CAC) or pooled cohort equation (PCE) scoring. Logistic regression models adjusted for clinical and socioeconomic cardiac risk factors were performed to assess the independent association between HIV status and CCTA plaque prevalence.
Results
Our sample had a high burden of clinical risk factors and socioeconomic risk factors, with 54.65% having hypertension, 40.51% currently smoking, and 51.16% living below the poverty line. These risk factors were broadly similar between WLH and WWoH, except WWoH were more likely to have diabetes (32% vs 9.84%, p=0.02). Although there was a high prevalence of CCTA plaque in the sample, WLH were not more likely to have CCTA plaque than WWoH (52.46% vs 52%, p=0.97). Adjusted regression analysis yielded similar results, with low income being the only covariate independently associated with CCTA plaque (OR [95% CI]: 5.65 [1.86, 19.3], p=0.003). Among those with a CAC score of 0 or PCE < 7.5%, WLH were numerically more likely to have CCTA plaque, but this did not reach statistical significance.
Conclusion
Despite HIV not being associated with coronary plaque prevalence, we saw a high burden of coronary artery disease in this cohort of Black women asymptomatic of cardiac symptoms, even among those at low cardiac risk. Asymptomatic Black women with elevated socioeconomic and clinical risk may need more stringent cardiac screening.
Table of Contents
Table of Contents
Table 1: Sample Characteristics by HIV Status
Table 2: Adjusted associations between listed cardiovascular and sociodemographic cardiovascular risk factors and coronary plaque prevalence. Covariates include HIV (ref: no HIV), body mass index, age, creatinine, diabetes (ref: no diabetes history), hyperlipidemia (ref: no hyperlipidemia history), hypertension (ref: no hypertension history), current smoking (ref: no current smoking), statin use (ref: no statin use), income (ref: >12,000$), education (ref: below high school education), and marital status (ref: married/partner). Significant associations are denoted with p<0.05.
Figure 1: Overall plaque prevalence and subtype plaque prevalence in (A) the overall sample (n=86), (B) among individuals with a CAC score of 0 (n=48 (66.7%)), and (C) among individuals with low or borderline cardiac risk (PCE score <7.5%, n=29 (58%)).
Figure 2: Overall plaque prevalence and subtype plaque prevalence by HIV subtype in (A) the overall sample (WLH: 61 (70.9%), WWoH: 25 (29.1%)), (B) among individuals with a CAC score of 0 (WLH: 33 (68.8%), WWoH: 15 (31.3%)), and (C) among individuals with low or borderline cardiac risk (PCE score <7.5%, WLH: 25 (86.2%), WWoH: 4 (13.8%)).
About this Master's Thesis
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Coronary Plaque Prevalence Among Black Women Living with HIV () | 2025-09-09 11:46:58 -0400 |
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