Association of Cardiac Troponin T With Coronary Atherosclerosis in Asymptomatic Primary Prevention People With HIV
Year: 2024
Type: article
Abstract: Background: Coronary plaque is common among people with HIV (PWH) with low-to-moderate traditional atherosclerotic cardiovascular disease (ASCVD) risk. Objectives: The purpose of this study was to determine the association of high-sensitivity cardiac troponin T (hs-cTnT) levels with coronary plaque characteristics and evaluate if hs-cTnT improves identification of these features beyond traditional ASCVD risk factors among PWH. Methods: Among PWH receiving stable antiretroviral therapy with low-to-moderate ASCVD risk and no known history of ASCVD, hs-cTnT levels and measures of plaque by coronary computed tomography angiography were assessed. Primary outcomes included the association of hs-cTnT level with the presence of any plaque, vulnerable plaque, coronary artery calcium (CAC) score, and Leaman score. Assessment of model discrimination of hs-cTnT for plaque characteristics was also performed. Results: The cohort included 708 U.S. participants with a mean age of 51 ± 6 years, 119 (17%) females, a median ASCVD risk score of 4.4% (Q1-Q3: 2.5%-6.6%), and a median hs-cTnT level of 6.7 ng/L (detectable level ≥6 ng/L in 61%). Any plaque was present in 341 (48%), vulnerable plaque in 155 (22%), CAC>100 in 68 (10%), and a Leaman score >5 in 105 (15%). After adjustment for ASCVD risk score, participants with hs-cTnT >9.6 ng/L (highest category) versus an undetectable level (<6 ng/L) had a greater relative risk for any plaque (1.37, 95% CI: 1.12-1.67), vulnerable plaque (1.47, 95% CI: 1.16-1.87), CAC>100 (2.58, 95% CI: 1.37-4.83), and Leaman score >5 (2.13, 95% CI: 1.32-3.46). The addition of hs-cTnT level modestly improved the discrimination of ASCVD risk score to identify critical plaque features. Conclusions: In PWH without known ASCVD, hs-cTnT levels were strongly associated with and improved prediction of subclinical coronary plaque. (Evaluating the Use of Pitavastatin to Reduce the Risk of Cardiovascular Disease in HIV-Infected Adults [REPRIEVE]; NCT02344290).
Source: JACC Advances
Authors: Christopher deFilippi, Sara McCallum, Markella V. Zanni, Kathleen V. Fitch, Marissa R. Diggs, Gerald S. Bloomfield, Carl J. Fichtenbaum, Judith A. Aberg, Carlos D. Malvestutto, Adriana Pinto-Martinez, Ann Stapleton, Joan Duggan, Gregory K. Robbins, Jana Taron, Julia Karady, Borek Foldyna, Michael T. Lu, Heather J. Ribaudo, Pamela S. Douglas, Steven K. Grinspoon
Institutions: Inova Health System, Harvard University, Massachusetts General Hospital, Duke University, University of Cincinnati, Icahn School of Medicine at Mount Sinai, The Ohio State University Wexner Medical Center, The Ohio State University, Hospital Universitario 12 De Octubre, Eisenhower Medical Center, University of Toledo, University of Freiburg, University Medical Center Freiburg, Semmelweis University, Duke Medical Center
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,850
OpenAlex ID: W4401633862