Statin effect on coronary calcium distribution, mass and volume scores and associations with immune activation among HIV+ persons on antiretroviral therapy.

Background Inflammation has been associated with whole heart coronary artery calcification (CAC) among people with HIV (PWH) on antiretroviral therapy (ART); however, prior studies have not evaluated the distribution of calcium or separated mass vs. volume scores, which are differentially associated with clinical events in the general population. Statins may also have a greater effect on CAC mass compared to volume. Methods One-hundred and forty seven PWH were randomized 1:1 to rosuvastatin 10mg or placebo and followed for 96 weeks. We re-analyzed coronary calcium scans from 0, 48, and 96 weeks to determine mass and volume scores and measures of CAC diffusivity. Mixed effects models and generalized estimating equations were used to examine longitudinal associations of CAC with treatment and biomarkers. Results Median age at study entry was 46 years; 78% were male and 68% African American. Median CD4+ was 613 and half were on protease-inhibitors. Randomization to statin therapy was not associated with a change in mass score, volume score, number of involved vessels, or diffusivity index (all p>0.1). Soluble CD14 was associated with the presence of CAC (p = 0.05) and borderline associated with number of involved vessels (p= 0.07) across all 3 time points. Conclusions In PWH on ART, moderate intensity rosuvastatin does not appear to have a significant effect on volume, mass, or regional distribution of CAC over 96 weeks. We extend previous cross-sectional observations to show that soluble CD14 is associated with whole heart CAC over time and independently of age and systolic blood pressure.