Subclinical Cardiac Pathology Common in Women With HIV

In women with antiretroviral therapy (ART)-treated HIV, there is a 3-fold increase in intramyocardial triglyceride content and reduced diastolic function, according to study results published in The Journal of Clinical Endocrinology & Metabolism.

Previous studies have shown a 4-fold increased risk for heart failure in ART-treated women with HIV, as well as increased cardiovascular and all-cause mortality rates in this population. In many cases, diastolic dysfunction in women with HIV antecedes clinical heart failure.

In the study, the researchers explored metabolic, hormonal, and immune parameters relating to diastolic dysfunction in women with HIV without prior cardiovascular disease (CVD).

The study included 19 ART-treated women with HIV aged 40 to 75 years without known CVD or diabetes, as well as 11 women without HIV matched for age and body mass index from the Greater Boston Area. All patients completed cardiac magnetic resonance spectroscopy and cardiac magnetic resonance imaging. The primary outcomes included intramyocardial triglyceride content and diastolic function in women with vs without HIV.

In women with HIV, intramyocardial triglyceride content was 3-fold higher (1.2% vs 0.4%; P =.01) and diastolic function was reduced (27.2%±9.6% vs 35.9%±6.4%; P =.007) compared with women without HIV. Other conventional magnetic resonance imaging measures did not differ between groups.

There was an inverse relationship between intramyocardial triglyceride content and diastolic function (P =.001). In women with HIV, intramyocardial triglyceride content predicted diastolic function even after controlling for known atherosclerosis CVD risk factors.

Within the whole group, intramyocardial triglyceride content did not vary by chronologic age but did increase across the reproductive aging continuum: 0.1% in premenopausal women, 0.4% in women with reduced ovarian reserve, and 1.1% in postmenopausal women (P =.02). The researchers also noted a direct relationship between hemoglobin A1c level and intramyocardial triglyceride content in women with HIV. HIV status (P =.01) and reproductive aging status (P =.02) remained independent predictors of intramyocardial triglyceride content even after adjusting for hemoglobin A1c and non-high-density lipoprotein cholesterol.

The researchers acknowledged several study limitations, including the small sample size, cross-sectional design, and possible inability to generalize these findings to women with HIV outside of the Greater Boston Area.

“Our work suggests that additional HIV-CVD research testing strategies to forestall myocardial steatosis and preserve diastolic dysfunction — particularly among aging [women with HIV] — may advance heart failure prevention efforts,” concluded the researchers.

Follow @EndoAdvisor

Reference

Toribio M, Neilan TG, Awadalla M, et al. Intramyocardial triglycerides among women with vs. without HIV: hormonal correlates and functional consequences [published online August 8, 2019]. J Clin Endocrinol Metab. doi:10.1210/jc.2019-01096