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

Christopher deFilippi; Sara McCallum; Markella V Zanni; Kathleen V Fitch; Marissa R Diggs; Gerald S Bloomfield; Carl J Fichtenbaum; Judith A Aberg; Carlos D Malvestutto; Adriana Pinto-Martinez; Ann Stapleton; Joan Duggan; Gregory K Robbins; Jana Taron; Julia Karady; Borek Foldyna; Michael T Lu; Heather J Ribaudo; Pamela S Douglas; Steven K Grinspoon

doi:10.1016/j.jacadv.2024.101206

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

JACC Adv. 2024 Aug 16;3(9):101206. doi: 10.1016/j.jacadv.2024.101206. eCollection 2024 Sep.

Authors

Christopher deFilippi¹, Sara McCallum², Markella V Zanni², Kathleen V Fitch², Marissa R Diggs², Gerald S Bloomfield³, Carl J Fichtenbaum⁴, Judith A Aberg⁵, Carlos D Malvestutto⁶, Adriana Pinto-Martinez⁷, Ann Stapleton⁸, Joan Duggan⁹, Gregory K Robbins¹⁰, Jana Taron^{11

12}, Julia Karady^{12

13}, Borek Foldyna¹², Michael T Lu¹², Heather J Ribaudo¹⁴, Pamela S Douglas¹⁵, Steven K Grinspoon²

Affiliations

¹ Inova Heart and Vascular Institute, Falls Church, Virginia, USA.
² Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Medicine, Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
⁴ Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁵ Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁶ Division of Infectious Diseases, Ohio State University Medical Center, Columbus, Ohio, USA.
⁷ HIV Unit, Hospital Universitario 12 De Octubre - Imas12, Madrid, Spain.
⁸ Eisenhower Health Center at Rimrock, Eisenhower Health, Rancho Mirage, California, USA.
⁹ Division of Infectious Diseases, University of Toledo, Toledo, Ohio, USA.
¹⁰ Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
¹¹ Department of Radiology, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.
¹² Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
¹³ Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
¹⁴ Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
¹⁵ Duke University Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.

Abstract

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).

Keywords: HIV; coronary artery disease; coronary computed tomography angiography; predictive modeling; troponin.

Associated data

ClinicalTrials.gov/NCT02344290

Grants and funding

UM1 AI069494/AI/NIAID NIH HHS/United States