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

•We investigated the prognostic value of epicardial adipose tissue and coronary artery calcium in 843 HIV+ patients.•Mean age 50 ± 8 years, 69% men; median follow-up 2.8 years; 15 incident myocardial infarctions and 18 all-cause deaths.•Both EAT and CAC were independently predictive of events on multivariable regression analyses.

BackgroundEpicardial 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.MethodsObservational 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.ResultsMean 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 = 0.038 and p = 0.001 respectively). Multivariable regression analyses demonstrated that the upper tertile of EAT (≥93 cc; OR 2.15, 95% CI 1.06 - 4.39, p = 0.034), and CAC score ≥100 (OR 3.37, 95% CI 1.49 - 7.60, p = 0.003) were independent predictors of events after adjusting for age and sex.ConclusionsIn this observational cohort of HIV patients, EAT and CAC were independent predictors of hard outcomes after a median follow-up of approximately 3 years.