Epicardial adipose tissue and coronary artery calcium predict incident myocardial infarction and death in HIV-infected patients

Background: Epicardial adipose tissue (EAT) and coronary artery calcium (CAC) have been associated with incident coronary artery disease (CAD) and all-cause mortality in the general population. Their prognostic impact in HIV is unknown. Methods: Observational study of 843 consecutive HIV-infected patients receiving antiretroviral therapy for at least 6 months. Risk stratification was performed with coronary artery calcium (CAC) scoring and EAT screening. Patients were followed for CAD and all-cause mortality for a median of 2.8 years accounting for a total of 2572 patient-year follow-up. Results: Mean patient age was 50 ± 8 years and 69% were men. At baseline EAT was associated with male gender, age, waist circumference, visceral adipose tissue, and lipodystrophy, while CAC score � 100 was associated with male gender, age and total cholesterol. During follow-up 33 patients suffered an event (15 incident myocardial infarctions and 18 deaths); the EAT volume was larger and the CAC score was higher in patients with events (p ¼ 0.038 and p ¼ 0.001 respectively). Multivariable regression analyses demonstrated that the upper tertile of EAT (� 93 cc; OR 2.15, 95% CI 1.06 e 4.39, p ¼ 0.034), and CAC score � 100 (OR 3.37, 95% CI 1.49 e 7.60, p ¼ 0.003) were independent predictors of events after adjusting for age and sex. Conclusions: In this observational cohort of HIV patients, EAT and CAC were independent predictors of hard outcomes after a median follow-up of approximately 3 years.