Association of Cardiac Troponin T With Coronary Atherosclerosis in Asymptomatic Primary Prevention People With HIV.

Autor:	deFilippi C; Inova Heart and Vascular Institute, Falls Church, Virginia, USA., McCallum S; Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA., Zanni MV; Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA., Fitch KV; Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA., Diggs MR; Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA., Bloomfield GS; Department of Medicine, Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA., Fichtenbaum CJ; Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Aberg JA; Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Malvestutto CD; Division of Infectious Diseases, Ohio State University Medical Center, Columbus, Ohio, USA., Pinto-Martinez A; HIV Unit, Hospital Universitario 12 De Octubre - Imas12, Madrid, Spain., Stapleton A; Eisenhower Health Center at Rimrock, Eisenhower Health, Rancho Mirage, California, USA., Duggan J; Division of Infectious Diseases, University of Toledo, Toledo, Ohio, USA., Robbins GK; Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA., Taron J; Department of Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.; Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA., Karady J; Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.; Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary., Foldyna B; Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA., Lu MT; Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA., Ribaudo HJ; Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Douglas PS; Duke University Research Institute, Duke University School of Medicine, Durham, North Carolina, USA., Grinspoon SK; Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	JACC. Advances [JACC Adv] 2024 Aug 16; Vol. 3 (9), pp. 101206. Date of Electronic Publication: 2024 Aug 16 (Print Publication: 2024).
DOI:	10.1016/j.jacadv.2024.101206
Abstrakt:	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). Competing Interests: The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute or the National Institute of Allergy and Infectious Diseases; the National Institutes of Health; or the U.S. Department of Health and Human Services. This study is supported through NIH grants U01HL123336, to the Clinical Coordinating Center, and U01HL123339, to the Data Coordinating Center as well as funding from Kowa Pharmaceuticals America, Inc, Gilead Sciences, and ViiV Healthcare. The NIAID supported this study through grants UM1 AI068636, which supports the Advancing Clinical Therapeutics Globally (ACTG) Network Leadership and Operations Center; and UM1 AI106701, which supports the ACTG Laboratory Center. This work was also supported by the Nutrition Obesity Research Center at Harvard (P30DK040561 to SKG). Dr deFilippi has received grant support to his institution from Roche Diagnostics and consulting for Roche Diagnostics which manufacturers the troponin T assay; has received grants to his institution from Abbott Diagnostics, FujiRebio, Quidel/Ortho, Siemens Healthineers, and the NHLBI outside this submitted work; consulting for Abbott Diagnostics, FujiRebio, and Quidel/Ortho, and Siemens Healthineers; and serves as a member of the clinical endpoint committee for Siemens Healthineers. Dr Zanni is the principal investigator of research grants from 10.13039/100000002NIH (NIAID and NHLBI) and from 10.13039/100005564Gilead Sciences to her institution and participating in a DSMB for 10.13039/100000002NIH-funded studies involving no compensation. Dr Fichtenbaum has received grant support through his institution from 10.13039/100005564Gilead Sciences, 10.13039/100010877ViiV Healthcare, 10.13039/100004330GSK, 10.13039/100005565Janssen, 10.13039/100006483Abbvie, 10.13039/100004334Merck, 10.13039/100002429Amgen, and Cytodyn, outside the submitted work; and personal fees from Theratechnologies and ViiV for consulting and participation on Advisory Board unrelated to REPRIEVE with Theratechnologies and ViiV, and role as Chair on DSMB for Intrepid Study, outside the submitted work. Dr Aberg has received institutional research support for clinical trials from Emergent Biosolutions, Frontier Technologies, Gilead Sciences, GlaxoSmithKline, Janssen, MacroGenics, Merck, Pfizer, Regeneron, and ViiV Healthcare; and personal fees for advisory boards from Glaxo Smith Kline/Viiv and Merck and participation on DSMB for Kintor Pharmaceuticals, all outside the submitted work. Dr Malvestutto has received institutional research support by Lilly; and honoraria from 10.13039/100010877ViiV Healthcare and 10.13039/100005564Gilead Sciences for Advisory Board membership, outside the submitted work. Dr Pinto-Martinez has received honoraria from Gilead, Janssen, and ViiV Healthcare for presentations and educational events, outside the submitted work. Dr Stapleton has received institutional research support by 10.13039/100000002NIH. Dr Robbins has received grant support to his institution from Leonard-Meron Bioscience; consulting fees to his institution from Seed Inc and Teradyne Inc; payment for expert testimony from Tufts Medical Center, participation on a DSMB for an NIH trial, and unpaid membership on a review panel for DHHS OI Guidelines. Dr Taron has received support from 10.13039/501100001659Deutsche Forschungsgesellschaft (DFG, German Research Foundation) relevant to the present work; consulting fees from Universimed Cross Media Content GmbH, Core Lab Black Forrest GmbH; and payments or honoraria from Siemens Healthcare GmbH, Bayer AG, outside of the submitted work. Dr Foldyna has received institutional support from 10.13039/100004325AstraZeneca, 10.13039/501100004628MedImmune, and MedTrace, outside of the submitted work. Dr Lu has received grant support through his institution from Kowa Pharmaceuticals America, Inc, for the conduct of the study; grant support from 10.13039/501100004628MedImmune and 10.13039/100004325AstraZeneca; and personal fees from PQBypass, outside of the current work. Dr Ribaudo has received grants from 10.13039/100000002NIH/10.13039/100000050NHLBI and Kowa Pharmaceuticals during the conduct of the study as well as grants from 10.13039/100000002NIH/10.13039/100000060NIAID, and 10.13039/100000002NIH/10.13039/100000050NHLBI, 10.13039/100000002NIH/10.13039/100000062NIDDK, and 10.13039/100000002NIH/10.13039/100000049NIA outside the submitted work. Dr Grinspoon has received grant support through his institution from Kowa Pharmaceuticals America, Inc 10.13039/100005564Gilead Sciences, Inc; and 10.13039/100010877ViiV Healthcare for the conduct of the study, as well as grants from Theratechnologies and Navidea and personal fees from Theratechnologies and ViiV, all outside the submitted work; and is a member of the Scientific Advisory Board of Marathon Asset management. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (© 2024 The Authors.)
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