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Allie Walpert, MSN
Pronouns
She/Her/Hers
Job Title
Collaborator (research NP)
Academic Rank
Department
Medicine
Authors
Allie R. Walpert, MSN, Suman Srinivasa, MD, Daniel Huck, MD, Marcelo F. DiCarli, MD, Sanjna Iyengar, BS, Grace Shen, BS, Teressa S. Thomas, MBBCh, Gail K. Adler, MD, PhD, Steven K. Grinspoon, MD
Principal Investigator
Steven K. Grinspoon, MD
Research Category: Cardiovascular, Diabetes, and Metabolic Disorders
Tags
Well-treated persons with HIV (PWH) have a 1.5-2.0-fold increased cardiovascular disease (CVD) risk compared to persons without HIV (PWOH). We assessed coronary microvascular function among PWH, comparing to PWOH and with diabetes mellitus (DM), a known CVD equivalent.
39 PWH with no known history of CVD or DM underwent coronary 13N-ammonia PET/CT to evaluate coronary flow reserve (CFR), a measure of microvascular function. Comparisons of CFR were made to PWOH from a database of higher risk clinical referrals to the BWH Division of Nuclear Medicine who were matched approximately 2:1 based on demographics and traditional risk factors and to those with diabetes and no known history of CVD recruited from a prior study evaluating CFR.
CFR was significantly different among groups (median, IQR): PWOH 2.76(2.37,3.36), PWH 2.47(1.92,2.93), DM 2.31(1.98,2.84), overall P=0.003. CFR was significantly reduced when comparing PWH to PWOH(P=0.02) and DM to PWOH(P=0.001) and did not differ when comparing PWH to DM(P=0.68).
Subclinical coronary microvascular dysfunction is present among asymptomatic, chronically infected PWH on antiretrovirals with good immunological control. CFR is reduced in HIV compared with higher risk PWOH and comparable to those with DM and may suggest that microvascular dysfunction contributes to increased CVD risk among PWH.
Persons with HIV (PWH) have double the risk for cardiovascular disease (CVD) compared to persons without HIV (PWOH). We assessed coronary function among PWH, comparing to PWOH and persons with diabetes mellitus (DM)—a group well known to be at risk for heart disease.
PWH with no history of CVD or DM underwent PET/CT imaging to evaluate coronary flow reserve (CFR)—a measure of flow through the small vessels in the heart which may indicate early CVD. Comparisons of CFR were made to PWOH from higher risk clinical referrals at BWH who had similar demographics and traditional risk factors and to those with diabetes and no history of CVD recruited as part of a prior study evaluating CFR.
CFR was significantly different among groups (median(1st quartile, 3rd quartile)): PWOH 2.76(2.37,3.36), PWH 2.47(1.92,2.93), DM 2.31(1.98,2.84), overall P=0.003. CFR was significantly reduced when comparing PWH to PWOH(P=0.02) and DM to PWOH(P=0.001) and did not differ when comparing PWH to DM(P=0.68).
Small vessel disease is present among well-treated PWH who have no symptoms of heart disease. This study demonstrates CFR is reduced in HIV compared with higher risk PWOH and that HIV is a CVD risk enhancing factor similar to diabetes.
