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

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

JACC: Advances (Sep 2024)

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

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

Affiliations

Christopher deFilippi, MD: Inova Heart and Vascular Institute, Falls Church, Virginia, USA
Sara McCallum, MPH: Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Markella V. Zanni, MD: Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Kathleen V. Fitch, MSN: Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Marissa R. Diggs, BA: Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Gerald S. Bloomfield, MD: Department of Medicine, Duke Global Health Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
Carl J. Fichtenbaum, MD: Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
Judith A. Aberg, MD: Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Carlos D. Malvestutto, MD: Division of Infectious Diseases, Ohio State University Medical Center, Columbus, Ohio, USA
Adriana Pinto-Martinez, MD: HIV Unit, Hospital Universitario 12 De Octubre – Imas12, Madrid, Spain
Ann Stapleton, MD: Eisenhower Health Center at Rimrock, Eisenhower Health, Rancho Mirage, California, USA
Joan Duggan, MD: Division of Infectious Diseases, University of Toledo, Toledo, Ohio, USA
Gregory K. Robbins, MD: Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Jana Taron, MD: Department of Radiology, Faculty of Medicine, Medical Center – University of Freiburg, University of Freiburg, Freiburg, Germany; Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Julia Karady, MD: Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
Borek Foldyna, MD: Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Michael T. Lu, MD: Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Heather J. Ribaudo, PhD: Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
Pamela S. Douglas, MD: Duke University Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
Steven K. Grinspoon, MD: Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Address for correspondence: Dr Steven Grinspoon, Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, Suite 750, Boston, Massachusetts 02114, USA.

Journal volume & issue: Vol. 3, no. 9
p. 101206

Abstract

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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 (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)

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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