Detection of subclinical coronary artery lesions by Framingham risk score, peripheral artery atheromatosis and coronary artery calcium score: a pilot study in asymptomatic individuals living with HIV.

BACKGROUND: The incidence of acute coronary events is increased among people living with HIV (PLWH) but there is no risk estimation score, nor a surrogate biomarker able to predict subclinical coronary artery disease (sCAD). We assessed the performance of: (i) Framingham risk score (FRMs), (ii) peripheral (carotid and femoral) artery atheromatosis, and (iii) coronary artery calcification score (CACs), to detect the presence of sCAD, in PLWH.

METHODS: In a cohort of PLWH free of CVD, we measured sCAD and CACs by computed tomography, calculated FRMs and assessed carotid/femoral plaques by ultrasound.

RESULTS: In 56 participants (age: 49± 10 years, men: 88%, FRMs: 7.2 ± 6.9; mean number of carotid/femoral plaques: 1.4±1.5; CACs>0 present in 59%, median CACs 0.9[(IQR 0-22]): (i) minimal sCAD (stenosis 1-24%; present in 30%) and mild sCAD (25-49%, 25%) were effectively detected by FRMs, number of plaques and CACs (AUC of CACs was better than that of both FRM and plaques, p<0.05); (ii) moderate sCAD (stenosis 50-69%; present in 8.9%) was detected by number of plaques and CACs, but similar AUC (0.969 vs 0.867, respectively, p=NS); (iii) severe sCAD (70-99%, present in only 3 [5.4%]) was detected only by CACs.

CONCLUSIONS: A high prevalence of sCAD in asymptomatic PLWH free of CVD was detected; CACs is a highly efficient biomarker to detect all grades of sCAD, however, the number of carotid/femoral plaques combined is also a very promising - lower cost and radiation free - surrogate biomarker. Future, larger studies are needed to verify these results.